B Acad Nat Med Paris
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B Acad Nat Med Paris · Jan 2003
Comparative Study[The importance of isolating septic patients in an autonomous unit in orthopedic surgery and traumatology].
To examine whether Sepsis Containment Units are presently in use by French Orthopedic surgeons in a number of hospitals and the subsequent efficacy of these measures in the prevention of risks linked to methicillin resistant Staphylococcus aureus (MRSA), MRSA was used as an example because it is the bacteria most frequently associated with infection in orthopedics. The transient carriage of MRSA on the hands of hospital personnel is the most common mechanism of patient to patient transmission. Consequently, the incidence of nosocomial MRSA in patients can be used to assess the quality of infection control. ⋯ Sepsis Containment Units are essential and merit further development.
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B Acad Nat Med Paris · Jan 2002
[Heart failure with preserved left ventricular function: clinical, echocardiographic, and clinical course features. Prognostic factors].
Heart failure is clinically associated with inadequate myocardial contraction, a significant reduction of left ventricular systolic function and ejection fraction and a cardiac enlargement. Some studies have reported that patients with symptomatic heart failure may have an impaired left ventricular filling with a normal or preserved left ventricular systolic function and an ejection fraction > 45%. These patients have a "diastolic heart failure" often neglected or misdiagnosed. ⋯ In conclusion heart failure with preserved left systolic ventricular function is frequent in women with hypertensive heart disease. The prognosis at mean term is better that prognosis of patients with systolic dysfunction but despite medical treatment there is a high morbidity with numerous re hospitalizations. Restrictive left ventricular filling pattern is significantly related to the occurrence of events and mortality.
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B Acad Nat Med Paris · Jan 2002
Case Reports Comparative Study[Major reconstructions of the hip by allograft composite prostheses (long-term follow-up of 34 cases)].
Reconstruction after major resections of malignant tumors can be achieved by association of prostheses and of massive allografts. In 34 patients, we could reconstruct: the proximal femur in 21 cases, after an average resection of 180 mm, with a "composite" allograft prosthesis (with a bone graft around the stem) or a "composite and combined" allograft prosthesis (in which the femur allograft was associated with the trochanteric tendons, to facilitate the reinsertion of the glutei muscles); 10 hemipelvis in which the cup was inserted in an hemipelvic allograft; 3 proximal femurs and acetabulum (with composite cups and stems). ⋯ The association of allografts and prostheses not only allows reconstructions which could be hardly achieved with only prostheses (especially for the pelvis), but also improves functional result and longevity, thanks to the biological fixation of the osseous and tendinous allografts. Considering our 15 years follow up in oncology, we have now extended these procedures to the major bone losses of the femur and pelvis following iterative revisions of standard prostheses for arthritis.
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Pollicization is a long time honored operation but more recent introduction of microsurgical techniques allowing toe to thumb transfers has changed the indications in trauma and congenital malformations. We reviewed two series of patients to assess the long-term result in both traumatized and malformed hands. Twenty-seven pollicized mutilated fingers were reviewed with a mean follow up of 9.5 years; the longest follow up published in the literature. ⋯ In congenital malformations, hypoplasia or aplasia of the thumb in presence of long fingers remains one of the best indication of pollicization. Out of 35 operated children, 27 were reviewed with a sufficient follow up (mean 6 years) to assess the result. Sensibility and growth were excellent (3 cases need some secondary shortening) mobility was close to normal in 61% of cases but the main concern was the strength which reached only 42% of the standard.
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B Acad Nat Med Paris · Jan 2000
[Conclusions. The precautionary principle: its advantages and risks].
The proposed extension to health of the precautionary principle is the reaction to two social demands: the desire for greater health safety and for more transparency in the decision making process by associating the public. In medical care, all decisions are based on the balance between cost (dangers induced by the treatment) and benefit (the therapeutic effect). It is as dangerous to overestimate the cost, in other words the risks, as it is to underestimate them. ⋯ The precautionary principle will also impose new obligations on the State, which also must conform to the requirements of proportionality between risk and action, transparency and information in the field of care and health. The application of the precautionary principle will require good judgment because the way it is implemented will determine whether its outcome will be for the better or the worse. That is why it is indispensable that jurists, medical practitioners, and scientists work together so that the precautionary principle will be as precisely defined and codified as possible.