Le but de cette étude est de calculer la densité minérale osseuse (DMO) d'un groupe de sujets atteints de syndrome de Marfan (MFS) selon les critères de Gand et de comparer ces résultats à un groupe ...de sujets sains.
Cent-trente patients atteints de MFS ont été examinés à la consultation multidisciplinaire consacrée au MFS. La DMO a été mesurée au col fémoral et au poignet par DEXA. Les mesures obtenues ont été comparées d'une part aux valeurs de la base de données contenue dans le densitomètre (Hologic QDR1000), et d'autre part à 72 adultes témoins sains de même taille et pour 35 d'entre eux comparables en taille et indice de masse corporelle (IMC).
Au plan clinique des antécédents de fractures ont été retrouvés chez 32 MFS (24–6 %). Les patients MFS ont une ostéopénie significative lorsque leur DMO est comparée aux valeurs de la base de données Hologic à la hanche : Z-score
=
–1,190
±
0,098
p
<
0,0001 et au poignet : –1,403
±
1,06
p
<
0,001. Les patients MFS comparés aux 72 témoins de même taille ont une ostéopénie significative mesurée au col fémoral : 0,841
±
0,15 (versus 1,010
±
0,017
p
<
0,0001). La comparaison des patients MFS de même taille et de même IMC retrouve une ostéopénie significative dans le groupe MFS. Aucune corrélation n'est retrouvée entre DMO et antécédents fracturaires et protrusions acétabulaires. Les patients MFS qui ont une ostéopénie DMO
<
–2,5 ont une fréquence plus importante d'ectasie durale.
Les patients des deux sexes atteints de MFS ont une ostéopénie significative indépendante de l'IMC.
Postoperative urinary retention Rosseland, Leiv Arne; Stubhaug, Audun; Breivik, Harald ...
Tidsskrift for den Norske Lægeforening,
2002-Apr-10, 20020410, Letnik:
122, Številka:
9
Journal Article
Recenzirano
Retention of urine is a common postoperative problem.
We present two patients with postoperative urinary retention. Current opinions on monitoring and treatment are reviewed.
One male postoperative ...patient was transferred from the postanaesthesia care unit after orthopaedic surgery under spinal anaesthesia. Shortly thereafter he collapsed. Hypotension and bradycardia were treated with intravenous ephedrine and atropine. Urinary retention was suspected and the bladder catheterised for 1,000 ml urine. A follow-up examination revealed no sequelae. A female patient was operated for haemorrhoids under epidural anaesthesia. The second postoperative day she was catheterised for 1,500 ml of urine. Two years later she had an ovarian cyst removed under general anaesthesia. Postoperative urinary retention developed with bladder overdistension (volume > 1,000 ml). A follow-up examination showed rest urine of 25 to 75 ml, and a chronic bladder dysfunction. The incidence of postoperative urinary retention varies depending upon type of surgery, gender, age, and preoperative history of urinary tract dysfunction. Method of anaesthesia or postoperative pain treatment is not correlated to incidence of urinary retention, but excessive intravenous volume load during the operation is.
Postoperative urinary retention should be monitored in all patients after surgery. All patients with history of difficulties with micturition need close supervision to avoid urinary bladder overdistention.
Abstract
Risk factors for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) have rarely been evaluated in intensive care units (ICU) without epidemic ...carbapenemase-producing Acinetobacter baumannii or Enterobacteriaceae. We addressed this issue in a cohort of 141 patients (previous antimicrobial exposure, n = 131) with a first episode of VAP in a medico-surgical ICU. Twenty-six VAP (18.4%) involved a CR-GNB (Pseudomonas aeruginosa, n = 14, Stenotrophomonas maltophilia, n = 11, and A. baumannii, n = 1), without previous carbapenem exposure in 12 (46.1%) cases. GNB resistant to all β-lactams except carbapenems were equally isolated in CR-GNB VAP (co-infections, 23%) and other episodes (30%). Previous exposure to aminoglycosides (odds ratio (OR) 1.14 per day, 95% confidence interval (CI) 1.02-1.30, p = 0.02) and the number of antimicrobial classes used before VAP (OR 1.38 per class, 95% CI 1.10-1.73, p = 0.006) were the only independent predictors of CR-GNB. These results suggest that the empirical use of a carbapenem-colistin combination should be evaluated in late-onset VAP following broad-spectrum antimicrobial exposure.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Le syndrome de Marfan et les fibrillinopathies Le Parc, Jean-Marie; Molcard, Sabine; Tubach, Florence ...
Revue du rhumatisme (Ed. française : 1993),
10/2000, Letnik:
67, Številka:
8
Journal Article
Le syndrome de Marfan est la plus fréquente des affections héréditaires du tissu conjonctif après l'ostéogenèse imparfaite. L'atteinte musculosquelettique est au premier plan de l'expression clinique ...du syndrome. Elle constitue un ensemble de symptômes physiques formant un des critères majeurs du diagnostic avec l'atteinte cardiaque et oculaire. Le diagnostic précoce du syndrome de Marfan est essentiel car il permet de mettre en place une série de mesures préventives qui ont permis d'allonger significativement l'espérance de vie de ces patients et de prévenir la survenue de déficits et de handicaps. Le syndrome de Marfan est consécutif à des mutations au sein du gène de la fibrilline 1, principale protéine du réseau microfibrillaire dont l'inventaire montre l'importance fonctionnelle dans la trophicité et la fonction du tissu élastique. La multidisciplinarité est un moyen unique et essentiel dans la prise en charge des patients et de leur famille.
Marfan’s syndrome is the second most common inherited connective tissue disorder, after osteogenesis imperfecta. The musculoskeletal abnormalities dominate the clinical presentation and produce a characteristic phenotype that is among the major diagnostic criteria, together with cardiac and ocular involvement. Early diagnosis is essential because appropriate preventive measures can significantly increase survival and reduce impairments and disabilities. Marfan’s syndrome is due to mutations within the gene encoding fibrillin 1, which is the main protein of the microfibril network. Fibrillin 1 influences elastic tissue nutrition and function. Multidisciplinary management of the patients and families is of the utmost importance.
This chapter describes the first controlled study on early prevention in France, with a psychodynamic, attachment-oriented approach. The theoretical basis of the intervention heavily drew from Selma ...Fraiberg's concepts: "Ghosts in the nursery", with the key concepts of developmental conflict between infant and a young mother. Ten maternity wards participated in recruitment for the study, with families living in the northern part of the City of Paris and in the suburbs. One significant result was a positive effect of the intervention on the use of the Protection Maternelle et Infantile as well as the use of mental health services. When infants were from twelve to sixteen months of age, their mothers were invited to participate in the CAPEDP-A study. Group supervision, twice a month, centred on risk issues for both the child and the mother, and sometimes for fathers. However, a home based preventive intervention is demanding and calls for a high level of supervision and support to be effective.
OBJECTIVE: Tuberculosis (TB) is associated with anti-tumor necrosis factor (anti-TNF) monoclonal antibody (mAb) therapy, but whether this association is drug-specific remains a concern. Our objective ...was to describe cases of TB associated with anti-TNF mAb therapy, identify risk factors, and estimate the incidence. METHODS: We conducted an incidence study and a case-control analysis to investigate the risk of newly diagnosed TB associated with the use of anti-TNF agents. As part of the French Research Axed on Tolerance of Biotherapies (RATIO) registry, for 3 years we collected cases of TB among French patients receiving anti-TNF mAb therapy for any indication; for each case, 2 patients treated with anti-TNF agents served as control subjects. RESULTS: We collected 69 cases of TB in patients treated for rheumatoid arthritis (n = 40), spondylarthritides (n = 18), inflammatory colitis (n = 9), psoriasis (n = 1) and Behçet's disease (n = 1) with infliximab (n = 36), adalimumab (n = 28), and etanercept (n = 5). None of the patients had received correct chemoprophylactic treatment. The sex- and age-adjusted incidence rate of TB was 116.7 per 100,000 patient-years. The standardized incidence ratio (SIR) was 12.2 (95% confidence interval 95% CI 9.7-15.5) and was higher for therapy with infliximab and adalimumab than for therapy with etanercept (SIR 18.6 95% CI 13.4-25.8 and SIR 29.3 95% CI 20.3-42.4 versus SIR 1.8 95% CI 0.7-4.3, respectively). In the case-control analysis, exposure to infliximab or adalimumab versus etanercept was an independent risk factor for TB (odds ratio OR 13.3 95% CI 2.6-69.0 and OR 17.1 95% CI 3.6-80.6, respectively). Other risk factors were age, the first year of anti-TNF mAb treatment, and being born in an endemic area. CONCLUSION: The risk of TB is higher for patients receiving anti-TNF mAb therapy than for those receiving soluble TNF receptor therapy. The increased risk with early anti-TNF treatment and the absence of correct chemoprophylactic treatment favor the reactivation of latent TB.
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