[Retrospective assessment of the influence of gestational age on the first trimester medical abortion efficiency]. / Evaluation rétrospective de l'efficacité de l'interruption volontaire de grossesse médicamenteuse au premier trimestre en fonction de l'âge gestationnel.

There are two methods of abortion : the medical and the surgical methods, each with its own specific benefits. Theoretically, the limit of medical abortion gestational age is 7 weeks of amenorrhea. However, since 2011, our university department provides the opportunity of a drug regimen until 9 weeks of amenorrhea. This paper describes the results of a retrospective study which covers 804 patients who were submitted to a medical abortion with gestational ages of 6 to 9 weeks. The purpose is to investigate the efficiency of the medical approach up to 9 weeks and to assess the drug dose required according to the term of pregnancy. Our work shows an efficiency of 95 % of medical abortion up to 9 weeks gestation, with no significant variation with the gestational age. However, maintaining this level of efficiency during the progress of pregnancy requires an increase of the administered doses of misoprostol. In addition, there is a significant increase in the use of analgesics. The medical abortion procedure remains effective until 9 weeks of gestation. This pharmacological approach reduces the risks induced, in the short and long term by the surgical procedure.

Il existe deux méthodes d'interruption de grossesse : la méthode médicamenteuse et la méthode chirurgicale, présentant chacune leurs avantages et leurs inconvénients. Théoriquement, la limite d'âge gestationnel pour l'IVG médicamenteuse est de 7 semaines d'aménorrhée. Cependant, depuis 2011, notre service universitaire a évalué la possibilité d'étendre l'indication à 9 semaines d'aménorrhée (SA).Cet article décrit les résultats d'une étude rétrospective qui porte sur 804 patientes ayant subi une IVG médicamenteuse avec un âge gestationnel allant de 6 SA à 9 SA. Le but de cette étude est de démontrer l'efficacité de la méthode médicamenteuse d'IVG jusqu'à 9 SA et d'évaluer les dosages médicamenteux nécessaires en fonction du terme de la grossesse. L'efficacité de l'IVG médicamenteuse est de l'ordre de 95 % jusqu'à 9 SA sans variation significative en fonction de l'âge gestationnel. Toutefois, le maintien de ce taux d'efficacité, lors de l'avancement de la grossesse, requiert une augmentation des doses de misoprostol administrées. De plus, on note une majoration significative du recours aux antalgiques. La procédure médicamenteuse d'IVG demeure efficace jusqu'à 9 SA. Cette approche réduit les risques induits par la procédure chirurgicale à court mais aussi à long terme.

[Pituitary apoplexy following coronary bypass surgery: A case report and literature review]. / Apoplexie hypophysaire après pontage aorto-coronarien : à propos d'une observation et revue de la littérature.

INTRODUCTION: Pituitary apoplexy is a >rare entity that presents with a sudden onset of headache associated with visual and endocrinological disturbances due to pituitary hemorrhage or infarction. It usually occurs in patients with an unknown pituitary adenoma. Cardiac surgery, and especially coronary artery bypass grafting, can be a precipitating factor in these patients. CASE REPORT: We report an 82-year-old male patient who presented with sudden headache and delirium, a right sixth cranial nerve palsy, a right temporal hemianopsia, and a severe loss of left eye visual acuity in the immediate post-operative course of a coronary artery bypass surgery. Pituitary apoplexy was demonstrated on both MRI and CT-scan. Trans-sphenoidal surgical decompression was performed 13 days after coronary artery bypass grafting, with immediate beneficial effect on the delirium and a partial recovery of visual disturbances. CONCLUSION: Pituitary apoplexy is a rare and life-threatening complication that may occur after cardiac surgery (coronary artery bypass, cardiac valve surgery), often precipitated by the use of cardiopulmonary bypass. It can occur after other surgical procedures (orthopedic, digestive, thoracic). The diagnosis must be considered during the early postoperative period in the presence of unusual and severe headache associated with visual disturbances.

[Satisfaction with technological equipment in individuals with tetraplegia following spinal cord injury]. / Enquête de satisfaction sur l'équipement technologique des personnes tétraplégiques par blessure medullaire.

OBJECTIVE: To measure the acquisition, use and satisfaction with high technology equipment by spinal cord injured tetraplegic subjects. DESIGN AND SETTING: A questionnaire was mailed to 102 tetraplegic subjects who were hospitalised in the rehabilitation center of Kerpape (Ploemeur, France) between 1998 and 2004, and 59 subjects responded. The questionnaire asked about the use of telephones, computers, wheelchairs and environmental controls at home. RESULTS: When a piece of equipment was acquired, it was very often used. Patient satisfaction with equipment was 79.3%. Home phones and mobile phones were often used with options such as hands-free devices (78 and 59% respectively). A total of 64.4% of subjects acquired a manual wheelchair and 61% a power wheelchair. The most commonly acquired options on the power wheelchairs were the powered recline (73,7%) and tilt (71,1%) systems. All options were used but all were more desired than acquired. A total of 27.1% of subjects desired a pushrim-activated power-assist wheelchair, but only 15.3% had acquired one; 695% of subjects had a computer. Communication was the first use for the computer (82.5%); 49.2% of subjects had acquired an environmental control system, but 20% desired one. The first reason for lack of acquisition was financial difficulties but also accessibility and information problems. The factor that influenced the acquisition and need for equipment was the degree of spinal cord injury. No other factor reduced patient satisfaction with equipment. CONCLUSION: Patients were satisfied with the equipment they acquired. But their needs, especially wheelchair options and environmental control systems, were not satisfied.

[Splenic artery thrombosis with Adepal. Pathogenic role of anti-ethinylestradiol antibody?]. / Thrombose de l'artère splénique sous Adépal. Rôle pathogène d'anticorps anti-éthinylestradiol?

We report a case of splenic artery thrombosis developed in a 54-year old woman after prolonged use of oral contraceptives. The diagnosis of the disease, difficult on clinical grounds, was confirmed by computerized tomography and selective arteriography. The presence of anti-ethinyloestradiol antibodies in the serum is suspected to be a risk factor for thrombosis associated with oral contraception.

[Arnold-Chiari II malformation and basilar impression. Report of one case (a literature review)]. / Malformation d'Arnold Chiari de type II et impression basilaire.A propos d'un cas (revue de la littérature).

OBJECTIVE: To tell the rare association of Arnold-Chiari II malformation and basilar impression and to describe an exceptional clinical state with a particular surgical approach. MATERIALS AND METHODS: To analyse a case of a patient suffering from this congenital malformation, her progressive clinical state, the surgical approach. RESULTS: N.G. a 42-year-old woman, suffers from a cerebello-spino-medullar disturbance responsible for a major dependence and respiratory insufficiency with a risk of death. The results of the surgical treatment meant to decompress the craniovertebral junction are exceptional. DISCUSSION: The analysis of the literature show the special feature of this case as much for the rarity of the diagnosis as for the progressive clinical state and the remarkable post operative result. CONCLUSION: The association of these two malformations is seldom alluded to in the literature and such a post operative result has apparently never been described. In addition, this case tends to prove that a second operation's worth considering if the first has shown its short-fall whichever the patient's clinical state.

[Severe cholestatic hepatitis revealing a DRESS syndrome]. / Hépatite cholestatique sévère révélant un Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome.

INTRODUCTION: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a drug-induced hypersensitivity syndrome, characterized by rash, hyereosinophilia and multiorgan failure, including cytolytic hepatitis. CASE REPORT: A 75-year-old man, treated with amoxicillin/clavulanic acid, presented with jaundice and disabling pruritus associated with severe cholestatic hepatitis, related to a DRESS syndrome. Because of the persistence of cholestasis and the severity of pruritus, a treatment with corticosteroids and plasma exchanges was initiated, allowing a rapid and complete remission. CONCLUSION: Amoxicillin/clavulanic acid, although rarely described in the literature, is a rare cause of DRESS syndrome. Severe cholestatic hepatitis associated with disabling pruritus may be one of the systemic manifestations, with a good prognosis using corticosteroids and plasma exchanges.

Therapeutic patient education for stroke survivors: Non-pharmacological management. A literature review.

OBJECTIVES: Focus on the different therapeutic patient education (TPE) programs for stroke survivors found in the literature. Verify their content and efficacy. METHOD: A literature review was conducted by searching for entries from 1966 to 2011 in the Medline and Cochrane Library databases. The references for the accepted articles were taken into consideration and the articles corresponding to the criteria inclusion but not present within the initial search were selected. The keywords used were "self care", "self management", "patient education" and "stroke". Given the multiplicity of symptoms that may be addressed in TPE programs, and following expert advice, the symptoms were grouped after expanding the bibliographic search using the following, additional keywords: "dysphagia"; "swallowing disorder"; "urinary incontinence"; "caregiver"; "fall prevention"; "falling"; "injury"; "shoulder pain"; "physical activity"; "exercise"; "aphasia" and "cognitive impairment". RESULTS: We found 30 article abstracts. In the end, we only accepted seven articles on general TPE programs that were well structured and detailed enough. The TPE programs found in the literature were often of questionable methodological quality. The multiplicity of symptoms led to very general TPE programs that covered all possible stroke after-effects. The purpose of these programs was to reduce stress and anxiety, to improve quality of life and to alleviate psychosocial after-effects. A change in caregiver and patient behavior was observed at times. We expanded the bibliographic search to include scientific arguments that could help implement TPE programs for more specific targets. CONCLUSION: TPE programs for stroke survivors could be improved by standardizing and assessing programs that focus on a specific problem caused by the various possible after-effects of strokes. In order to promote education for stroke survivors, specific training for health care professionals and appropriate funding are necessary.

[Diabetogenic tropical pancreatitis]. / Pancréatite tropicale diabétogène.

The tropical calcifying pancreatitis and/or fibrous pancreatitis are responsible for a number of cases of juvenile insulin-dependent diabetes in the Third World countries. World wide distributed in the tropical areas of Asia, Africa and South America, they can also be observed in Europe, in migrants from these countries. Intensive epidemiological and biochemical studies are currently developed in order to shed light on the many obscure points. Classification of the typical calcifying pancreatitis and the related syndromes is a matter of debate. The pathological basis is calcification of the pancreas and echography of the gland may become a cheap convenient relatively specific tool for epidemiology. The clinical syndrome consists of chronic painful pancreatic episodes since childhood, associated with pancreatic exocrine insufficiency, followed by the onset, during adolescence, of diabetes mellitus, which is most of the times insulin dependent. Patients' history is free of chronic alcoholism, but includes constantly chronic caloric and proteic malnutrition. Although insulin dependent this diabetes in not prone to ketosis, due presumably to carnitine deficiency and relative glucagon deficiency (or suppressibility). Insulin resistance is traditionally noted, the pathophysiology of which is unknown. The mechanism of calcification appearance is also undetermined. Either a deficiency in pancreatic stone protein, or the toxic effect of cyanogen glucosides present in cassava and other tropical foodstuffs, or the malnutrition-related deficiency in sulphur-containing aminoacids may be causal factors. No valid experimental model of the disease is available.

Neurologic sequelae after severe falciparum malaria in adult travelers.

Severe falciparum malaria usually occurs in nonimmune patients, namely children in endemic areas or travelers returning from tropical areas. It generally has one of two outcomes: rapid death or cure without sequelae. Neurologic sequelae have been reported in children but have not been described in detail in adults. The purpose of this study was to determine the clinical spectrum, neuroimaging aspects and long-term outcome of these sequelae. We describe six imported cases of severe malaria with neurologic sequelae in adults, seen in a Parisian university hospital over a 10-year period. The most striking findings were neuropsychological disorders, in particular memory impairment and diffuse white matter damage on magnetic resonance imaging. Only three of the patients had made a full recovery after 6 months.