[Task delegation in primary care: new roles to the nursing personnel in Catalunya]. / La delegation de taches en soins primaires: les nouveaux roles des infirmieres en Catalogne.

A model of provision of primary care is experimented in a Catalan health centre. The model implies more varied roles and greater autonomy to nurses. They are the first contact of the patients coming to the health center. They base their decisions on a Guide for interventions on emergencies. The latter are distributed into 3 groups: (i) the cases which can be dealt with and finalized by the misusing the protocols previously established; (ii) the cases which require immediate care from the nurse, later intervention from the physician and common finalization at the end; (iii) the cases which require immediate intervention from the physician and, if the physician is not available, an evaluation from the nurse in the meanwhile. On 202 patients requesting a consultation on the same day, the data below are obtained:--70% cases have been resolved by the nurse using the Guide--14% cases have been resolved by the nurse after a telephone conversation with the physician--16% have been orientated to the relevant departments. Moreover, the on duty physician has been consulted in 6% The Guide appears therefore extremely useful. However, in the long range, the need for additional training in some specific domains were emerging, and that of constant interchange between physicians and nurses as well.

Lipoprotein (a) and risk of ischemic stroke in young adults.

UNLABELLED: Lipoprotein (a) [Lp(a)] is a LDL-particle linked to apoprotein (a) [apo(a)]. High Lp(a) plasma level is a risk factor for coronary heart disease and, in older men, for ischemic stroke. The role of Lp(a) as a risk factor for ischemic stroke in young adults is uncertain. METHODS: Lp(a) concentration was prospectively measured in 100 consecutive patients with acute ischemic stroke (58 men and 42 women) aged 18-55 years, and in 100 controls matched for age and gender. RESULTS: The distribution of Lp(a) concentration was skewed toward the highest and median tertiles in male patients. In multivariate logistic regression analyses adjusting on classical risk factors for ischemic stroke and lipid variables, Lp(a) concentration in the highest and medium tertiles compared with the lowest tertile was significantly associated with ischemic stroke in men (OR 3.55, 95% CI 1.33-9.48, p = 0.012), but was not in women (OR 0.42, 95% CI 0.14-1.26, p = 0.12). Although large vessel atherosclerosis was more common in men than in women, there were no differences in Lp(a) concentration according to the cause of ischemic stroke. CONCLUSION: Among subjects aged 18-55 years, a slightly elevated Lp(a) concentration was strongly and independently associated with ischemic stroke in men, but not in women. Further studies are required to elucidate the mechanisms underlying this gender-specific association.

Bacterial contamination of enteral nutrition in a paediatric hospital.

A prospective study was performed in a paediatric hospital to evaluate the incidence of bacterial contamination in enteral nutrition bags and to determine the critical points of process. During two separate one-month periods, all children receiving pump-assisted enteral nutrition were enrolled in the study. Samples for microbiological analysis were collected from enteral nutrition bags after administration in the first and second study period (sample T(2)). In the second study period, two additional samples were made at the end of the feed preparation process. One was refrigerated immediately (sample T(0)) and the other was sealed in a tube that followed the enteral nutrition solution until the end of its administration (sample T(1)). Bacterial contamination was detectable above 10(2)cfu/mL. Twenty-six out of 40 patients were included in the first study period and 14 out of 44 in the second study period. Contamination (>10(2)cfu/mL) occurred in nine of 26 samples (35%) and seven of 14 samples (50%) in the first and second study periods, respectively. Of these, five (20%) and three (21%) contained significant contamination (>/=10(4)cfu/mL). Bacteria of low pathogenicity were found in T(0) samples. Bacteria present in T(2) samples were pathogenic and multiple in 50% of cases. These results suggest that manipulation of the enteral nutrition bags at the bedside is critical for bacterial safety.

Bipallidal haemorrhage after ethylene glycol intoxication.

Acute or subacute bipallidal lesion, an uncommon radiological feature produced by metabolic disorders or poisoning, has never been attributed to ethylene glycol (EG) intoxication. This 50-year-old Afro-Caribbean alcoholic man had unexplained loss of consciousness. Blood tests showed osmolar gap. Drug screening was positive for EG at 6.06 mmol/l. Brain CT revealed bilateral pallidal haemorrhage. Pallidal haematoma, which could be related to deposition of oxalate crystals issued from EG metabolism, should lead to toxicological screening.

Fertility and outcomes of pregnancy after chemotherapy in a sample of childbearing aged women.

The aim of the study was to review the characteristics and outcomes of pregnancies occurring in women of childbearing age after chemotherapy for malignant disease. Between November 1998 and October 1999, a total of 16 patients who were treated for ovary (three), mole (one), vaginal (one), breast (four), Hodgkin's disease (four), lung (one), melanoma (one) and osteosarcoma (one) carcinoma were identified and retrospectively questioned about their fertility status. All the 16 women included in this study received at least one alkylating agent. Five patients (31%) experienced anomalies of hormonal cycle during and after the treatment. All of them recovered normal cycle without consequence of fertility. Caesarean section was performed in seven of 20 (35%) pregnancies with known outcomes. No obstetrical events were reported. The 16 women had 21 pregnancies resulting in 18 normal infants, one newborn with a minor abnormality (tallus foot), one spontaneous abortion and one lost of follow-up to 6 months of pregnancy. The present survey suggests that cytotoxic drug exposure had no deleterious effects on subsequent pregnancies. A prospective and systemic survey would be the only means able to clarify the actual cancer therapy on reproductive outcome and to investigate the long-term effects in the progeny.

[Atlanto-occipital luxation and syringomyelia: 2 rare complications of cervical injury. Diagnostic and therapeutic effects. Apropos of a case]. / Luxation occipito-atloïdienne et syringomyélie: deux complications rares de la traumatologie cervicale. Incidences diagnostiques et thérapeutiques. A propos d'un cas.

The authors report the case of a 19 years old patient with an undiagnosed traumatic atlanto-occipital dislocation complicated after two years by a rapidly evolutive syringomyelia. This clinical case which associates two rare complications of cervical traumatology allows to discuss the problems of both pathologies especially on the following points: --The early diagnosis of the dislocation by tomography and CT scan is the only mean to treat totally these lesions and perhaps to avoid the complications like syringomyelia. --In case of delayed diagnosis, when the dislocation is "fixed" the complete decompressive surgery both by a posterior and a trans-oral way is for the authors the treatment of choice.

[Computer-assisted measurement of intracranial pressure. The Pic Part system]. / Mesure de la pression intra-cranienne assistée par ordinateur. Le système Pic Part.

In this article the authors describe a computer assisted pressure measuring equipment: the PIC PART system which allows real time visualisation of intracranial and possibly arterial pressure, and above all the automatic analysis of measures after long casting recording (24 hours).

[Diagnostic and therapeutic problems of osteomeningeal defects and traumatic cerebrospinal fluid defects of the anterior floor of the base of the skull. Apropos of 95 cases]. / Problèmes diagnostiques et thérapeutiques des brèches ostéoméningées et des fistules liquidiennes traumatiques de l'étage antérieur de la base du crâne. A propos de 95 cas.

The authors here report teaching drawn from the latest ninety five cases of osteo-dural defects in basilar skull fractures they have surgically treated. They particularly insist on the following points: Difficulties in establishing a clinical diagnosis when the traumatism is in its acute stage: initially 55% of patients do not show any symptom of rhinorrhea, so that the diagnosis is only based on X-ray data. Previous to any surgical treatment the number of serious septic meningitis is rather high in as much as it reaches 10.55% in this series. Risk of infection together with bone damages incite the authors to suggest a surgical treatment of dural defects in their acute stage, namely within the two weeks following the accident. The study of results shows that due to treatment complications, are not insignificant. The authors then tackle the problems of technics and osteo-dural restoration. They, at last, explain, in this series, the interest of preventive antiepileptic treatment by hydantoins during and after the operation. Despite complications due to treatment the results in this series appear to be significant enough to allow the authors to place the indication of the surgical treatment of traumatic osteo-dural defects in basilar skull at the acute stage of their evolution.

[Acute post-traumatic tetraparesis: a developmental complication of cervical arthrosis. Physiopathology, clinical study, prognosis. Apropos of 6 cases]. / Tétraparésie aiguë post-traumatique: accident évolutif de l'arthrose cervicale. Physiopathologie, étude clinique, pronostic. A propos de 6 cas.

After dealing with the anatomo-pathology of arthrosis, and then the physio-pathology of cervico-arthrotic myelopathy, the authors describe just now six cases of acute post-traumatic tetraplegia happening as a complication of cervical arthrosis. They do insist on the circumstances of that unexpected coming of such neurologic accidents, on their prognosis very often pejorative, on the necessity of a preventive surgical treatment at the stage of cervico-arthrosis myelopathy not very evolved, which is the only one accurate device to avoid the acute decompensation, insisting at last on the functional sequela most often severe of these complications.

[Brachial plexus block anesthesia in the upper limb surgery (author's transl)]. / Blocs du plexus brachial dans la chirurgie du membre supérieur. A propos de 139 cas.

This work, during a period of 2 years, has been carried out on 139 brachial plexus block anesthesias out of which --92 through axillary approach--47 through supraclavicular approach. Our failure rate was--6,5 p. cent in the case of the axillary block--10,6 p. cent in the case of the supraclavicular block. This gives us a failure average of 7,9 p. cent. Depending on the duration of the operation we have been using three kinds of drugs, always without adrelanine--Lidocaïne . . . 2 p. cent--Mepivacaïne . . . 2 p. cent--Bupivacaïne . . . 0,5 p. cent. We finally adopted two mixtures based on lidocaïne together with mepivacaine or bupivacaine keeping the same concentration but reducing to half the doses of these last two drugs. In our work, we have not noted any complication, and we think that a locoregional anesthesia, should, as far as it is possible, be used as a substitute for general anesthesia instead of being used when general anesthesia is contra-indicated.

[Specific soluble antigens and Listeria monocytogenes typing by electrosyneresis (author's transl)]. / Antigènes solubles spécifiques et typage de Listeria monocytogenes par électrosynérèse.

Listeria monocytogenes releases its antigens during the exponential phase. Electrosyneresis on agarose allows detection of these antigens in the supernatant of broth culture following a 3 h incubation of the strains. This serotyping method seems to be easy, rapid and reproductible. The authors have investigated 83 strains of different origines and find no difference with agglutination. However, during the stationary phase, L. monocytogenes releases other antigens which gave precipitation lines with all commercial sera tested.

[Study on the degradation products of mecinarone]. / Contribution a l'etude des produits de degradation de la mecinarone

The isolation and identification of degradation products of mecinarone produced when the drug is exposed to heat, light or a mild oxidant are described. A method for separating these products by low pressure liquid chromatography is presented.