B Acad Nat Med Paris
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The transplantation of multiple abdominal viscera including liver-duodenum-pancreas, liver-stomach-duodenum-pancreas, and liver-intestine is being performed with increasing frequency and success. These procedures and other variations are derived from a seldom used multivisceral operation in which all of the foregoing organs are transplanted in bloc. It is described here how the full multivisceral transplantation and its less extensive derivatives are based on the same principles of procurement, preservation, and postoperative management. ⋯ Even with avoidance of rejection and GVHD, metabolic interrelations between the grafted organs, and also between the graft organs and retained recipient viscera can affect the fate of the individual transplanted organs or retained recipient organs. The best delineated of these metabolic influences are mediated by the endogenous splanchnic hepatotrophic factors of which insulin has been the most completely studied. An understanding of these various immunologic and non-immunologic factors combined with the more potent immunosuppression which is now available is sure to stimulate efforts at transplantation of abdominal organs and particularly of the hollow viscera which heretofore have resisted such clinical efforts.
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B Acad Nat Med Paris · Apr 1991
Review Case Reports[Heart transplantations: impact on female fertility].
Improvements in the management of patients with cardiac transplantation make it possible for these patients in the child-bearing age to expect a pregnancy. In fact, since 1987, several cases of pregnancy after cardiac transplantation have been reported. We report here two cases of successful pregnancy two years after cardiac transplantation. ⋯ Preexisting hypertension is increased, particularly during the third trimester of pregnancy and during labour. The incidence of preterm labor is increased in patients with heart transplant. Transplant rejection never occurred during pregnancy.
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In France, emergencies are taught: to all medical students in the course of their studies; a specific emergency course being rarely given as such; to physicians who want to practice in emergency system: transport, emergency rooms, in association with intensive care medicine. The head of the emergency service should have a full time position, and whatever his original specialty, should receive a specific education in critical care medicine. Nurses who attend different congresses to complete their formation are not yet rewarded with a specific status. In addition, first aid measures should be thought to the general public, so it can help injured persons.
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Authors have previously published April 1988 a lecture where they criticize the bad denomination "passed coma" full of ambiguity for public mind, to which "brain death" ought to be preferred. In the present communication, they remark that this last denomination is not absolutely exact because the real site of responsibility of death is the "brain stem", or to say better the medulla. They discuss of some explorative tests of this part of the encephalon.
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B Acad Nat Med Paris · Nov 1990
Review[Socioeconomic aspects of human immunodeficiency virus (HIV) infection in developing countries].
The assessment of the socio-economical aspects of the human immunodeficiency virus (HIV) infection is difficult because of the relative scarcity of information. This study addresses mainly the socio-economic aspects of the AIDS pandemic in the inter-tropical zone of Africa, which, at the moment, constitutes the epicenter of the disease. In the absence of a possible radical treatment, the HIV infection prevalence should range between 25 and 30 million individuals by the year 2000 in the world, and the number of cases of AIDS, between 5 and 6 million, among which 4 to 5 million in the developing world alone. ⋯ Already, losses caused by AIDS screening and its medical treatment in five countries of Central Africa should exceed the total amount of the foreign assistance received by each country. The estimated economic weight of the AIDS attendance is 15 to 20 times more heavy for a developing country than for an industralized one. Overcoming economically the cost of AIDS is an objective impossible to reach for deprived countries.