La Revue du praticien
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The lessons drawn from real reactor accidents are of great value. The safety approach in France relies on defence in depth and takes into account accidents in the plant design, completed by a probabilistic approach and experience feedback. ⋯ Off site countermeasures, such as in house-confinement, limited evacuation or iodine distribution, are efficient in limiting the consequences for the public. Experience feedback, in association with a proactive vigilance and prevention policy, is developed in order to detect and correct in a proactive way the root causes of any deviation, even minor, so as to avoid multiple failures and ensure safety.
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Thirty per cent of the carpal dislocations are missed although a significant injury was sustained by the wrist. The extent of the ligamentous tears is relative to the magnitude of the forces applied and the anterior lunate dislocation corresponds to the more severe lesions. ⋯ Conservative treatment of a perilunate dislocation results very frequently in carpal instability and subsequently in wrist osteoarthritis after a variable period of time. Surgical treatment is now indicated in a great majority of cases, for reduction and fixation of a displaced scaphoid, or for ligament repairs.
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La Revue du praticien · Oct 1994
Review[Treatment of bacterial meningitis in newborn infants and children].
Third generation cephalosporin as cefotaxime or ceftriaxone is the best first line treatment. Duration of treatment is 7 to 10 days in uncomplicated disease. Dexamethasone used very early--before or at the same time of the antibiotic injection--seems to decrease sensorial sequelae. ⋯ In newborns, morbidity is higher, due in part to brain abscesses. Therapeutic choice is not the same for materno-foetal and postnatal infection. Antibiotherapy duration is, at least, 15 days and 21 days for gram-negative bacteria.
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Epidemic bacterial meningitis in the adult and the elderly are essentially due to Streptococcus pneumoniae. Neisseria meningitidis and Listeria monocytogenes. ⋯ Treatment associates an antibiotic having rapid antibactericidal action in the CSF, suppression of possible foci of primary infections and intensive care required by the frequency of associated visceral insufficiency. Present research is centered on: 1. the appearance and progression of pneumococcal lines resistant to penicillin; 2. the trials of modulators of the inflammatory response, notably dexamethasone; 3. the improvement of antibiotic concentrations in the CSF and the cerebral parenchyma, particularly in listeria infection.