B Acad Nat Med Paris
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B Acad Nat Med Paris · Jan 2000
Biography Historical Article[One hundred years ago --Jules Fontan and the wounded heart].
On the event of the centennial of the first wound of the left ventricule cured by suture, the author recalls the conditions under which Jules Fontan, surgeon of the Navy, obtained this memorable success. He recalls the first observation and analysed the obstacles which this surgeon had to overcome to finally open the era of surgical treatment of heart wounds caused by knife fights. A comparative study of diagnostic and therapeutic approaches implemented one hundred years later highlights the advances made in the area of heart wound surgery and also in planned heart surgery for which the 20th century will remain of all achievements.
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B Acad Nat Med Paris · Jan 1999
Multicenter Study Comparative Study Clinical Trial[Sudden cardiac death: the chain of survival in France].
In 1991 the concept of chain of survival was widely accepted. In France, one of the main difficulties was to perform early defibrillation. Only physicians were authorized to use defibrillators and the survival rate was not better than 1 to 2%. ⋯ The survival rate of the 317 FV was 15.1% (9.5% without neurological impairment). This results are encouraging but not sufficient. Since 1998, AED can be legally used by non physicians professionals, but the others links of the chain have to be improved, particularly by educating the public.
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B Acad Nat Med Paris · Jan 1999
Review[Current data on major novel antiamalaria drugs: Artemisinin (qinghaosu) derivatives].
Artemisinin or Qinghaosu (QHS) and its derivatives (mainly artemether and artesunate) are novel and the most rapidly acting antimalarial drugs, effective in adults and children against all the Plasmodium of humans, including multi-drug resistant Plasmodium falciparum. Resistance to these drugs has not been identified so far. QHS derivatives are very well tolerated and there is no evidence of serious clinical toxicity in man. ⋯ This route eliminates several disadvantages or risks associated with injections. The best indication for rectal administration will be probably a rescue treatment of severe malaria in rural and poorly equipped dispensaries before transfer to hospital for treatment using conventional modalities. All QHS derivatives should not be used for chemophophylaxis.
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We are faced with difficult and complex questions that cannot be answered by stating great principles or ideological convictions, because they refer to painful situations, always singular, in which each individual, in a unique way, faces his life and his death. But the debate can draw on shared convictions and values. Thus, before being a way of assuming death, the Christian faith is fundamentally a way of welcoming the life, in all times and in its fullness, that Christ has given us. ⋯ When that image of dignity gets shaky, one discovers sorts of dignity that do not answer those criteria, but that testify that any "body" can be a subject, and that we know nothing about it. Lastly, no law or moral authority, be they lax or restrictive, can suppress compassion, nor the ethical responsibility of the patient, of the doctors, of the family circle. None can take the place of the common requirement: go along with life up to death.
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B Acad Nat Med Paris · Jan 1998
Review[Interactions between central opioidergic and cholecystokininergic systems in rats: possible significance for the development of of opioid tolerance].
Numerous data suggest that cholecystokinin (CCK) acts as an opioid-modulating peptide. Because pharmacological and behavioural studies have shown that CCK reduces the analgesic effects of opioids, an opioid-mediated activation of CCK-containing neurones has been proposed to be responsible for the development of opioid tolerance. In an attempt to directly assess this hypothesis, we have examined, in naive or morphine-tolerant/dependent rats, the possible influence of opioid-receptor ligands on--1 the release of CCK from spinal cord slices and--2 the extracellular levels of CCK in the frontal cortex in awake, freely moving animals. ⋯ In contrast, the delta 2-mediated increase in CCK release persisted. Thus, in morphine-tolerant/dependent rats, opioids apparently retain only their excitatory effects on CCK-containing neurones. These data support the idea that morphine exerts an excitatory influence on central CCKergic neurones, which could tend to reduce the analgesic action of the alkaloid, and are in line with the hypothesis that morphine tolerance/dependence is associated with an activation of CCK-containing neurones.