B Acad Nat Med Paris
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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 (...).
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After defining surrogate pregnancy and distinguishing cases in which the surrogate mother simply bears the child from those in which she is also the egg donor, the authors summarize foreign legislation in this area, together with the task force subs auditions and the literature. They list arguments for and against removing the current coup ban on surrogate motherhood. Arguments for include:--infertility due to the lack of a uterus, either congenitally or following hysterectomy, or to functional destruction of the uterus, repeated failure of in vitro fertilization, and the existence of a disorder that would threatening the future mother's life if she became pregnant;--perception of this infertility and the resulting suffering as an injustice;--the lack of alternative solutions;--the difficulties of adoption, and the fact that the adopted child does not carry the genes of the adopting parents;--the current recourse to surrogate mothers abroad, which is costly and discriminatory and leaves the child in a difficult legal situation on its return to France;--the generally satisfactory observed outcomes. ⋯ The French National Academy of Medicine considers that surrogate pregnancy is not only a medical matter but one that raises questions for society as a whole and should be dealt with principally by the legislator. In contrast, the Academy considers that it is within its remit to consider the possible complications that might ensue if this practice were to be legalized. The Academy points out that the long-term mental and physical risks are poorly assessed and recommends that, if surrogate pregnancy were to be legalized, the risks should be strictly evaluated, both objectively and transparently, and the practice should be strictly controlled.