B Acad Nat Med Paris
-
B Acad Nat Med Paris · Jan 1995
Review[Controlled hypercapnia: a new strategy in the treatment of severe respiratory insufficiency].
Permissive hypercapnia (PHY) represents an interesting approach in critically ill ventilated patients, because it allows to ensure adequate gas exchange while avoiding the adverse effects related to excessive airway pressures. Its objective is to improve oxygenation while reducing the risk of barotrauma and circulatory impairment. ⋯ This good tolerance legitimizes two strategies: firstly to accept hypercapnia in conditions such as acute severe asthma for which enforced normalization of PaCO2 would imply potentially lethal complications, and secondly to deliberately induce respiratory acidosis while using very low airway pressures and alveolar ventilation to limit or prevent overdistension lung damage in injured as well as in normal areas. When the cerebral vasodilation induced by CO2 might aggravate a preexisting intracranial disorder, PHY is obviously contraindicated.
-
Thanks to technological advances handicaps can be treated in a better way by physicians. This real Metrology of Handicap constitutes a preliminary stage to medical decision. Functional repercussions of a lesion can thus be accurately assessed before the well adapted compensatory means are conceived, prescribed and applied. ⋯ On the other hand, priorities in aims of an increasingly demanding individual economy will be dictated by collective economy focused on cost management. However, the concept of increase in life expectancy without disability will be relevant in the determination of health policy and the role of rehabilitation physicians will be all the more important because they are the only one to be able to coordinate a team qualified to choose and apply the best therapeutics. Times are over when below-knee amputees were directly referred to the orthoprosthetist after segmentation, At the present time, psychologists cannot decide alone on the re-orientation of patients with brain trauma and, Domoticians will never organize the life place of tetraplegic subjects.
-
Handicap has heavy economic implications. Pensions, whose the amount is about 127 billions of french francs, are paid, every year, to disabled persons. ⋯ The risk of dependency in the elderly has led to a deep change in the allocation of many savings. Rehabilitation cost-effective programs are contributive to reduce handicaps; significant demonstrations has been given for many common diseases as low back pain, post-stroke hemiplegia, osteoporosis.
-
B Acad Nat Med Paris · Apr 1994
Review[Parasitic specificity and development of stray parasites of animal origin in man].
As on introduction to the selected topic, the author, after conjuring up the problem of parasite specificity, describes the various biological behaviour of parasites of animal origin having got into man. So doing, he quotes two main types of parasitic zoonoses (1) holozoonoses, in which the parasites are able to pass from animals to man and back; (2) hemi-zoonoses, in which parasites cannot go back from man to animals. The latter are due: (a) either to the inability for the parasite to reach, in man, the stage which would enable it to follow on its life cycle; this is a biological phenomenon: man is a dead-lock for the parasite; (b) or to the necessity for a parasite having reached a suitable stage in man, to go back-to animal through predation of man by the animal; this is an ethological phenomenon: man is a cul-de-sac for the parasite.
-
B Acad Nat Med Paris · May 1992
Review[Congenital indifference and congenital insensitivity to pain].
Congenital indifference to pain is often mistaken for congenital insensitivity. It is characterized by the occurrence since childhood of lesions, mainly cutaneous and osteoarticular secondary to strictly painless traumas. However, despite the lack of pain, the patient is able to discriminate a painful stimulus. ⋯ Congenital analgesia is associated with anhidrosis in Swanson's syndrome (in which Lissauer the tractus is absent in the spinal cord) and with dysautonomia in Riley-Days's disease (in which there is a lack of amyelicinic fibres). On account of these data, some authors refuse the autonomy of congenital indifference and classify it in the group of the various autonomic and sensory neuropathies. However it seems justified to acknowledge the congenital analgesia with two varieties: congenital indifference in which there is no sensation of pain but normal sensory pathway and tonic function of endomorphinic system, congenital insensitivity in which the painful stimulus is not transmitted to the central nervous system.