B Acad Nat Med Paris
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B Acad Nat Med Paris · Nov 2009
[Emerging multidrug-resistant microorganisms among travelers returning to France and persons repatriated from foreign hospitals].
The spread of multidrug-resistant bacteria has become a major problem in France in recent years, owing to increasing antibiotic exposure, growing international exchanges, repatriation of hospitalized French patients, and treatment of French and foreign travelers in French hospitals. This article examines how different pathogens may become endemic in France.
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Many data are available on the epidemiology of type 2 diabetes in France (ENTRED 2007, DIABASIS 2008). It is currently estimated that 2.2 million people (3.8% of the population) have type 2 diabetes, with a higher prevalence among those with lower socioeconomic status. Ninety-five per cent of patients are over 45 years of age, 52% are male, 71% are overweight, 54% have hypertension, 18% have elevated LDL cholesterol, 19% have elevated triglyceride levels, and 13% are smokers. ⋯ In particular, plasma glucose levels must be determined regularly in all people over 45 years of age and in all subjects at risk of diabetes. Management of hyperglycemia and other risk factors must be more aggressive and adapted to disease progression. Patient follow-up must be improved, taking in account the entire healthcare infrastructure, and especially structures involved in the treatment of obesity and diabetes.
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Lung transplantation has become an established treatment for end-stage pulmonary failure refractory to medical management. However, the scarcity of lung grafts and the growing number of candidates has led to an increase in deaths among patients on waiting lists. Despite improvements in donor management, organ preservation, and the use of marginal and cardiac-death donors, only about 20% of candidate lungs are currently being transplanted. ⋯ Indeed, a significant number of rejected lungs can now be retrieved and transplanted with acceptable results. Given the longer storage times provided by this technique, transplantation can be programmed, with better surgical efficiency. In the near future, a new mobile organ-care machine should become available, along with laboratories dedicated to ex vivo reconditioning of all lung grafts before their transplantation.
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B Acad Nat Med Paris · Jun 2009
Review[Spa therapy in rheumatology. Indications based on the clinical guidelines of the French National Authority for health and the European League Against Rheumatism, and the results of 19 randomized clinical trials].
The objective of this work was to update the rheumatologic indications of spa therapy, based on clinical practice guidelines published by the French National Authority for Health (HAS) and the European League Against Rheumatism (EULAR), and on the results of randomized clinical trials (RCT) METHODOLOGY: We first examined the indications for which spa therapy is mentioned and/or recommended in HAS and EULAR guidelines. We then identified RCTs in spa therapy and rheumatology by using the key words spa therapy, balneology, balneotherapy, hydrotherapy, mud therapy and mineral water in the Pubmed, Pascal and Embase databases. Only RCTs including a statistical analysis of between-group outcomes were retained We also examined the possible contribution of RCTs not listed in the bibliography of the guidelines. ⋯ Spa therapy, or hot-water balneology, appears to be indicated for chronic low back pain, stabilized rheumatoid arthritis, ankylosing spondylitis and fibromyalgia. RCT findings suggest that patients with knee and hand osteoarthritis might also benefit.
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First developed in the 1960s, interventional neuroradiology has vastly improved the management of patients with vascular diseases of the brain and spine, including vascular malformations and stroke. Gradually replacing open-skull neurosurgical approaches, endovascular occlusion of ruptured intracranial aneurysms has improved the post-bleed prognosis. ⋯ A wide range of therapeutic strategies are available for brain arteriovenous malformations, including hyperselective embolization, open-skull surgery, radiosurgery, and abstention. The choice depends on multiple parameters, including symptoms, clinical status, the angioarchitecture of the malformation, and the patient's psychology and wishes (...).