The size, shape, density and ring of the dwarf planet Haumea from a stellar occultation.

Haumea-one of the four known trans-Neptunian dwarf planets-is a very elongated and rapidly rotating body. In contrast to other dwarf planets, its size, shape, albedo and density are not well constrained. The Centaur Chariklo was the first body other than a giant planet known to have a ring system, and the Centaur Chiron was later found to possess something similar to Chariklo's rings. Here we report observations from multiple Earth-based observatories of Haumea passing in front of a distant star (a multi-chord stellar occultation). Secondary events observed around the main body of Haumea are consistent with the presence of a ring with an opacity of 0.5, width of 70 kilometres and radius of about 2,287 kilometres. The ring is coplanar with both Haumea's equator and the orbit of its satellite Hi'iaka. The radius of the ring places it close to the 3:1 mean-motion resonance with Haumea's spin period-that is, Haumea rotates three times on its axis in the time that a ring particle completes one revolution. The occultation by the main body provides an instantaneous elliptical projected shape with axes of about 1,704 kilometres and 1,138 kilometres. Combined with rotational light curves, the occultation constrains the three-dimensional orientation of Haumea and its triaxial shape, which is inconsistent with a homogeneous body in hydrostatic equilibrium. Haumea's largest axis is at least 2,322 kilometres, larger than previously thought, implying an upper limit for its density of 1,885 kilograms per cubic metre and a geometric albedo of 0.51, both smaller than previous estimates. In addition, this estimate of the density of Haumea is closer to that of Pluto than are previous estimates, in line with expectations. No global nitrogen- or methane-dominated atmosphere was detected.

A ring system detected around the Centaur (10199) Chariklo.

Hitherto, rings have been found exclusively around the four giant planets in the Solar System. Rings are natural laboratories in which to study dynamical processes analogous to those that take place during the formation of planetary systems and galaxies. Their presence also tells us about the origin and evolution of the body they encircle. Here we report observations of a multichord stellar occultation that revealed the presence of a ring system around (10199) Chariklo, which is a Centaur--that is, one of a class of small objects orbiting primarily between Jupiter and Neptune--with an equivalent radius of 124 ± 9 kilometres (ref. 2). There are two dense rings, with respective widths of about 7 and 3 kilometres, optical depths of 0.4 and 0.06, and orbital radii of 391 and 405 kilometres. The present orientation of the ring is consistent with an edge-on geometry in 2008, which provides a simple explanation for the dimming of the Chariklo system between 1997 and 2008, and for the gradual disappearance of ice and other absorption features in its spectrum over the same period. This implies that the rings are partly composed of water ice. They may be the remnants of a debris disk, possibly confined by embedded, kilometre-sized satellites.

Albedo and atmospheric constraints of dwarf planet Makemake from a stellar occultation.

Pluto and Eris are icy dwarf planets with nearly identical sizes, comparable densities and similar surface compositions as revealed by spectroscopic studies. Pluto possesses an atmosphere whereas Eris does not; the difference probably arises from their differing distances from the Sun, and explains their different albedos. Makemake is another icy dwarf planet with a spectrum similar to Eris and Pluto, and is currently at a distance to the Sun intermediate between the two. Although Makemake's size (1,420 ± 60 km) and albedo are roughly known, there has been no constraint on its density and there were expectations that it could have a Pluto-like atmosphere. Here we report the results from a stellar occultation by Makemake on 2011 April 23. Our preferred solution that fits the occultation chords corresponds to a body with projected axes of 1,430 ± 9 km (1σ) and 1,502 ± 45 km, implying a V-band geometric albedo p(V) = 0.77 ± 0.03. This albedo is larger than that of Pluto, but smaller than that of Eris. The disappearances and reappearances of the star were abrupt, showing that Makemake has no global Pluto-like atmosphere at an upper limit of 4-12 nanobar (1σ) for the surface pressure, although a localized atmosphere is possible. A density of 1.7 ± 0.3 g cm(-3) is inferred from the data.

A Pluto-like radius and a high albedo for the dwarf planet Eris from an occultation.

The dwarf planet Eris is a trans-Neptunian object with an orbital eccentricity of 0.44, an inclination of 44 degrees and a surface composition very similar to that of Pluto. It resides at present at 95.7 astronomical units (1 AU is the Earth-Sun distance) from Earth, near its aphelion and more than three times farther than Pluto. Owing to this great distance, measuring its size or detecting a putative atmosphere is difficult. Here we report the observation of a multi-chord stellar occultation by Eris on 6 November 2010 UT. The event is consistent with a spherical shape for Eris, with radius 1,163 ± 6 kilometres, density 2.52 ± 0.05 grams per cm(3) and a high visible geometric albedo, Pv = 0.96(+0.09)(-0.04). No nitrogen, argon or methane atmospheres are detected with surface pressure larger than ∼1 nanobar, about 10,000 times more tenuous than Pluto's present atmosphere. As Pluto's radius is estimated to be between 1,150 and 1,200 kilometres, Eris appears as a Pluto twin, with a bright surface possibly caused by a collapsed atmosphere, owing to its cold environment. We anticipate that this atmosphere may periodically sublimate as Eris approaches its perihelion, at 37.8 astronomical units from the Sun.

Charon's size and an upper limit on its atmosphere from a stellar occultation.

Pluto and its satellite, Charon (discovered in 1978; ref. 1), appear to form a double planet, rather than a hierarchical planet/satellite couple. Charon is about half Pluto's size and about one-eighth its mass. The precise radii of Pluto and Charon have remained uncertain, leading to large uncertainties on their densities. Although stellar occultations by Charon are in principle a powerful way of measuring its size, they are rare, as the satellite subtends less than 0.3 microradians (0.06 arcsec) on the sky. One occultation (in 1980) yielded a lower limit of 600 km for the satellite's radius, which was later refined to 601.5 km (ref. 4). Here we report observations from a multi-station stellar occultation by Charon, which we use to derive a radius, R(C) = 603.6 +/- 1.4 km (1sigma), and a density of rho = 1.71 +/- 0.08 g cm(-3). This occultation also provides upper limits of 110 and 15 (3sigma) nanobar for an atmosphere around Charon, assuming respectively a pure nitrogen or pure methane atmosphere.

Large changes in Pluto's atmosphere as revealed by recent stellar occultations.

Pluto's tenuous nitrogen atmosphere was first detected by the imprint left on the light curve of a star that was occulted by the planet in 1985 (ref. 1), and studied more extensively during a second occultation event in 1988 (refs 2-6). These events are, however, quite rare and Pluto's atmosphere remains poorly understood, as in particular the planet has not yet been visited by a spacecraft. Here we report data from the first occultations by Pluto since 1988. We find that, during the intervening 14 years, there seems to have been a doubling of the atmospheric pressure, a probable seasonal effect on Pluto.

Epidemiology of the vascular assessment and correlation of the WIfI Classification in lower limb amputee patients at Martinique university hospital in 2018.

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.

Long-term results of valve replacement with the St. Jude Medical prosthesis.

To assess with truly long follow-up the long-term results of valve replacement with the St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.), we reviewed the case histories of the first 1112 patients undergoing 1244 valve replacements with this valve between June 12, 1978, and June 12, 1987: 690 male (62%) and 422 female patients, mean age 56 years. A total of 773 patients (69%) had the aortic valve replaced, 207 (19%) the mitral valve, and 132 (12%) the aortic and mitral valves. There were 42 hospital deaths (3.8%). Follow-up was 97.5% complete (8988 patient-years). There were 213 late deaths. Ninety-one (43%) were considered valve-related: sudden death, n = 27; anticoagulant-related hemorrhage, n = 22; thromboembolism, n = 19; prosthetic valve endocarditis, n = 13; valve thrombosis, n = 9; and noninfectious perivalvular leak, n = 1. Overall actuarial survival, including hospital mortality, was 68% +/- 6% (95% confidence limits) 14 years after the operation. Linearized rates of late valve-related events were as follows: thromboembolism, 1.09% per patient-year; anticoagulant-related hemorrhage, 0.94% per patient-year; prosthetic valve endocarditis, 0.32% per patient-year; valve thrombosis, 0.33% per patient-year; and perivalvular leak, 0.19% per patient-year. Actuarial freedom, at 14 years, from thromboembolism was 89% +/- 3%, anticoagulant-related hemorrhage 83% +/- 8%, valve thrombosis 97% +/- 1%, and reoperation 95% +/- 3%. Actuarial freedom from all valve-related deaths and valve-related morbidity and mortality, at 14 years, was 84% +/- 6% and 61% +/- 8%, respectively. We conclude that, because of its low thrombogenicity, low incidence of valve-related events, and low valve-related mortality, the St. Jude Medical valve is one of the best performing mechanical prosthesis currently available. Nevertheless, the late valve-related complications and deaths illustrate that the quest for a "perfect" prosthesis remains unfulfilled.

Aortic stent-graft for patent ductus arteriosus in adults: the aortic exclusion technique.

The risk of closure of a patent ductus arteriosus in the elderly is high because of the fragility of the aorta and aneurysmal change in the ductus. Stent-grafting has emerged as a method of treatment of pathology of the aorta. We describe a case where this new endovascular technique has been successfully applied for closure of a patent ductus arteriosus in a high-risk patient. It may become part of the armamentarium for this pathology in adults.

Risk factors for early mortality after valve surgery in Europe in the 1990s: lessons from the EuroSCORE pilot program.

BACKGROUND AND AIM OF THE STUDY: The characteristics of valve surgery are evolving. The study aim was to explore its demographics and risk factors in Europe in the 1990s, using the EuroSCORE database. METHODS: For the EuroSCORE program, information on 98 variables regarding risk factors, procedures and outcome were collected for 5,672 patients undergoing valve surgery under cardiopulmonary bypass in 128 European centers. Bivariate (i.e. Mann-Whitney test or chi-square when appropriate), then logistic regression analyses were carried out to identify risk factors for early mortality. The predictive value of EuroSCORE was analyzed using the Hosmer-Lemershow test and by computing the area under the receiver operating characteristic (ROC) curve. RESULTS: Aortic valve stenosis was the most common diagnosis (47.6%), whilst mitral valve surgery accounted for 42% of procedures. Coronary surgery was performed concomitantly in 21% of cases. Hospital mortality was 6.1%. Predictive factors for early mortality were: age (p = 0.0001), preoperative serum creatinine >200 micromol/l (p = 0.014), previous heart surgery (p = 0.0001), poor left ventricular function (p = 0.008), chronic congestive heart failure (p = 0.0001), pulmonary hypertension (p = 0.0001), active acute endocarditis (p = 0.0001), emergency procedure (p = 0.05), critical preoperative status (p = 0.0001), tricuspid surgery (p = 0.015), aortic and mitral surgery (p = 0.002), combined thoracic surgery (p = 0.0001), and combined coronary surgery (p = 0.0001). The predictive value of EuroSCORE for mortality was good (area under the ROC curve = 0.75). CONCLUSION: The 'valve' subset of the EuroSCORE database provides an instant picture of European valve surgery in the 1990s that can be used either for individual assessment, or for country- or institution-based epidemiological studies of risk factors and practices.

Conservative surgery for atrioventricular valve myxoma.

Patients with valvular myxoma are usually candidates for surgery because of the high incidence of life-threatening embolism. In some cases, the tumor is sessile or presents with a large peduncle: complete excision may then lead to valve replacement. We report two cases of atrioventricular valve myxoma where replacement was avoided. In one patient, a mitral myxoma appended from the edge of the anterior leaflet close to the chordae insertion; safe excision implied destruction of the two chordae and a peritumoral section of the anterior leaflet. A chordal transposition technique was used to preserve valve competence. In a second patient, a tricuspid myxoma causing syncopal episodes was resected; this was characterized by a large stalk, located on the anterior tricuspid leaflet away from chordal attachment and the valvular annulus. Treatment was by resection and the leaflet reconstructed with a pericardial patch. Techniques for conservative treatment of degenerative valvular disease or endocarditis, when monitored peroperatively by transesophageal echocardiography, may be successful in the surgical resection of atrioventricular myxoma.

Role of pre-operative assessment in the surgical management of leiomyoma extended to the right heart chambers: a compendium of information from isolated reports.

Recurrent intravenous leiomyoma extending to the right heart chambers is extremely rare. A large range of surgical techniques and approaches (i.e. two-step procedure, hypothermia and circulatory arrest) have been previously described. We report a recent case where the tumour was excised in a one-step procedure under normothermic cardiopulmonary bypass. This report associated to a comprehensive literature review allows us to discuss the role of pre-operative assessment and to propose refinement of surgical techniques according to the anatomy of the tumour.

Does EuroSCORE work in individual European countries?

OBJECTIVE: Because of national epidemiological differences in adult heart surgery in Europe, the effectiveness and desirability of a pan-European score for the assessment of quality of surgical care remains controversial. We assessed the predictive value of EuroSCORE in national subsets of the EuroSCORE database. METHODS: The EuroSCORE development data set was divided into national subsets of which those with 500 or more patients were selected for analysis. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model on individual national samples and the areas under the receiver operating characteristic (ROC) curve were measured to analyse the EuroSCORE discriminative power on individual death prediction. RESULTS: There were 18676 patients in the six largest national samples: Germany, United Kingdom, Spain, Finland, France and Italy (mean: 3113 patients; range: Finland 1266 to France 4507). Major differences were observed in national distribution of procedures: coronary artery bypass grafting accounted for 77.7% of procedures in Finland but only 46.2% in Spain. The EuroSCORE model goodness-of-fit was satisfactory in all countries (P-value overall: 0.4; UK: 0.34; Finland: 0.87; no values less than 0.05). Areas under ROC curves were 0.81 in Germany, 0.79 in the UK, 0.74 in Spain, 0.87 in Finland, 0.82 in France and 0.82 in Italy. CONCLUSION: Despite epidemiological differences between European countries, the discriminative power of EuroSCORE was good in Spain and excellent in all other countries. The system, developed from a merged European database, can therefore be used to assess improvement in quality of care achieved by surgeons and institutions as well as for international European comparison in adult heart surgery.

Quality of care in adult heart surgery: proposal for a self-assessment approach based on a French multicenter study.

A prospective study was carried out from January to April 1993 in 42 centers to assess the quality of care in adult heart surgery in France. One hundred eight parameters were collected (i.e., risk factors, surgery, postoperative course) for 7181 patients. Eight simple, objective factors were selected using a multivariate analysis. Point weighting was assigned to each factor. A simple cumulative score was thereby established to classify patients within four incremental risk groups (respective distribution of patients and mortality were 38.6%, 26.5%, 21.3%, 13.5% and 2%, 3.9%, 6.1%, 21.4%). This score was highly predictive for mortality and severe morbidity. Objectivity and independence of the observer, coupled with a reliable score, are needed for meaningful assessment of the quality of care. Administrative supervision and/or comparison of raw center results therefore remain controversial. A national data base was developed as a part of this study, that includes anonymous information from two-thirds of all cardiac surgery cases. Nation-wide results for France allow each center freely to assess its results. This self-assessment approach is, in our view, the most accurate way of quality of care assessment. A pan-European system using a similar approach should be developed.

European system for cardiac operative risk evaluation (EuroSCORE).

OBJECTIVE: To construct a scoring system for the prediction of early mortality in cardiac surgical patients in Europe on the basis of objective risk factors. METHODS: The EuroSCORE database was divided into developmental and validation subsets. In the former, risk factors deemed to be objective, credible, obtainable and difficult to falsify were weighted on the basis of regression analysis. An additive score of predicted mortality was constructed. Its calibration and discrimination characteristics were assessed in the validation dataset. Thresholds were defined to distinguish low, moderate and high risk groups. RESULTS: The developmental dataset had 13,302 patients, calibration by Hosmer Lemeshow Chi square was (8) = 8.26 (P < 0.40) and discrimination by area under ROC curve was 0.79. The validation dataset had 1479 patients, calibration Chi square (10) = 7.5, P < 0.68 and the area under the ROC curve was 0.76. The scoring system identified three groups of risk factors with their weights (additive % predicted mortality) in brackets. Patient-related factors were age over 60 (one per 5 years or part thereof), female (1), chronic pulmonary disease (1), extracardiac arteriopathy (2), neurological dysfunction (2), previous cardiac surgery (3), serum creatinine >200 micromol/l (2), active endocarditis (3) and critical preoperative state (3). Cardiac factors were unstable angina on intravenous nitrates (2), reduced left ventricular ejection fraction (30-50%: 1, <30%: 3), recent (<90 days) myocardial infarction (2) and pulmonary systolic pressure >60 mmHg (2). Operation-related factors were emergency (2), other than isolated coronary surgery (2), thoracic aorta surgery (3) and surgery for postinfarct septal rupture (4). The scoring system was then applied to three risk groups. The low risk group (EuroSCORE 1-2) had 4529 patients with 36 deaths (0.8%), 95% confidence limits for observed mortality (0.56-1.10) and for expected mortality (1.27-1.29). The medium risk group (EuroSCORE 3-5) had 5977 patients with 182 deaths (3%), observed mortality (2.62-3.51), predicted (2.90-2.94). The high risk group (EuroSCORE 6 plus) had 4293 patients with 480 deaths (11.2%) observed mortality (10.25-12.16), predicted (10.93-11.54). Overall, there were 698 deaths in 14,799 patients (4.7%), observed mortality (4.37-5.06), predicted (4.72-4.95). CONCLUSION: EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history. We recommend its widespread use.

Is the Parsonnet's score a good predictive score of mortality in adult cardiac surgery: assessment by a French multicentre study.

OBJECTIVE: Parsonnet proposed a preoperative score ("initial Parsonnet's score", which predicts the hospital mortality of adult cardiac surgery. This score was then modified by including several risk factors used in the 'SUMMIT' system ("modified Parsonnet's score", 44 variables). We wanted to assess the predictive value of these two scores in a French surgical population. METHODS: From December 1992 to April 1993, in France, we organised a prospective multicentre study on adult cardiac surgery mortality and morbidity. Data on 6649 patients were included. We analysed statistically the predictive value of each risk factor and of the two scores on mortality and morbidity at one month. RESULTS: Only 6 of the 15 variables of the initial Parsonnet's score and 19 of the 44 variables of the modified Parsonnet's score significantly influence hospital mortality. Both scores are able to predict hospital mortality and severe morbidity, but the modified Parsonnet's score has the best predictive value (initial Parsonnet's score: odds ratio by point of score = 1.01, area under the roc curve = 0.64; modified Parsonnet's score: odds ratio by point of score = 1.05, area under the roc curve = 0.70). CONCLUSIONS: This study shows that the Parsonnet's scores are predictive, but that these scores remain imperfect: many risk factors are non significant, the initial Parsonnet's score has a moderate predictive value, and the modified Parsonnet's score is too complex (44 variables). Thus, we have built a new score for cardiac surgery in French adults.

Coronary surgery in Europe: comparison of the national subsets of the European system for cardiac operative risk evaluation database.

OBJECTIVE: To compare the national samples of patients who underwent isolated coronary artery bypass grafting (CABG) during the European System for Cardiac Operative Risk Evaluation (EuroSCORE) trial in order to evaluate national differences in epidemiology, patient risk profile and surgical methods. METHODS: From September to November 1995, 11731 patients had CABG in the six largest contributing nations to the EuroSCORE project: Germany, UK, Spain, Finland, France and Italy. The Chi-square and Kruskal-Wallis tests were applied to obtain an international comparison of patient general status, including pre-operative risk factors, cardiac status, critical pre-operative states, rare conditions, urgency of surgery, angina status, coronary lesions, procedures and EuroSCORE risk assessment. RESULTS: Large national samples (from 984 patients in Finland to 3138 in Germany) identified significant differences in epidemiology, risk profile and surgical practice. Regarding epidemiology, CABG accounted for 62.8% of adult cardiac surgery, with a range of 46.2 in Spain to 77.7% in Finland (P<0.001). The mean age was 62.9 years (61.4 in Britain to 64.4 in France, P<0.001). The mean body mass index was 26.8 (26 in France to 27.5 in Finland, P<0.001). With regard to risk profile, diabetes was present in 20.3% of patients (11.8% in Britain to 27.7% in Spain, P<0.001). Chronic renal failure was present in 8.3% (6.8% in Germany to 10.6% in Spain, P<0.001). Chronic airway disease affected 3.8% (1.9% in Italy to 5. 1% in Germany, P<0.001). The mean ejection fraction was 0.56 (0.48 in Britain to 0.58 in Finland, P<0.001). The mean predicted mortality (according to EuroSCORE) was 3.3% (2.8% in Finland to 3.6% in France, P<0.001). The prevalence of chronic congestive heart failure, unstable angina and recent myocardial infarction also showed statistically significant differences. No differences were found for some critical preoperative states (such as immediate preoperative cardiac massage and pre-operative intubation), or for surgery for catheter laboratory complication. Regarding surgical practice, major differences were noted in preoperative intra-aortic balloon use (mean 1%, Finland 0%, Spain 2.3%, P<0.001), the number of mammary artery conduits used (mean 0.9, Spain 0.7, France 1.1, P=0.0001) and the number of distal anastomoses (mean 3, France 2.7, Finland 3.8, P=0.001). CONCLUSION: There are important epidemiological differences in the national cohorts of CABG patients in the EuroSCORE database. Any international comparison of European surgical results must therefore take into account the risk profile of patients by using a compatible risk stratification system.

Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients.

OBJECTIVE: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS: From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to influence hospital mortality. The relationship between risk factors and outcome was assessed by univariate and logistic regression analysis. RESULTS: Mean age (+/- standard deviation) was 62.5+/-10.7 (range 17-94 years) and 28% were female. Mean body mass index was 26.3+/-3.9. The incidence of common risk factors was as follows: hypertension 43.6%, diabetes 16.7%, extracardiac arteriopathy 2.9%, chronic renal failure 3.5%, chronic pulmonary disease 3.9%, previous cardiac surgery 7.3% and impaired left ventricular function 31.4%. Isolated coronary surgery accounted for 63.6% of all procedures, and 29.8% of patients had valve operations. Overall hospital mortality was 4.8%. Coronary surgery mortality was 3.4% In the absence of any identifiable risk factors, mortality was 0.4% for coronary surgery, 1% for mitral valve surgery, 1.1% for aortic valve surgery and 0% for atrial septal defect repair. The following risk factors were associated with increased mortality: age (P = 0.001), female gender (P = 0.001), serum creatinine (P = 0.001), extracardiac arteriopathy (P = 0.001), chronic airway disease (P = 0.006), severe neurological dysfunction (P = 0.001), previous cardiac surgery (P = 0.001), recent myocardial infarction (P = 0.001), left ventricular ejection fraction (P = 0.001), chronic congestive cardiac failure (P = 0.001), pulmonary hypertension (P = 0.001), active endocarditis (P = 0.001), unstable angina (P = 0.001), procedure urgency (P = 0.001), critical preoperative condition (P = 0.001) ventricular septal rupture (P = 0.002), noncoronary surgery (P = 0.001), thoracic aortic surgery (P = 0.001). CONCLUSION: A number of risk factors contribute to cardiac surgical mortality in Europe. This information can be used to develop a risk stratification system for the prediction of hospital mortality and the assessment of quality of care.

[Evaluation method of social rehabilitation of adults who had suffered infantile psychoses]. / Méthode d'évaluation de l'insertion sociale d'adultes ayant souffert de psychose infantile.

This study attempts to find out the outcome of psychotic children as adults, essentially with regard to social adjustment, main prognostic variable. To avoid the biases of an institutional recruitment, our population was defined in a geographic area: the Herault department (2-4). In the international literature only 3 studies of outcome in adulthood (6-8) could be found. The procedure encountered many difficulties: geographic dispersion, lack of standardized assessment of social adjustment. The method used was chosen in order to compare with other studies. It describes: the present situation and psychiatric status of 47 persons, 17 to 24 year old (mean = 21 years); social characteristics with 6 variables: employment, school credits, living accommodation, leisure activities and interpersonal relationships, marital status, medical care utilization. A score of 0 (poor adjustment) to 3 (very good adjustment) was given for each of the previous variables. To make later analyses easier, we summarized these data into a single score: index of social adjustment. RESULTS Among the 47 persons, 41 have been located; 2 were dead. Most of them are young (18 subjects are 17 to 20 year old). 19 of them carry on special education or special vocational training. In specialized institutions, they are day-pupils or boarders depending on family possibilities. 8 persons are active: the level ranged from special job training to sheltered employment. 4 persons live in special centers for handicapped adults; according to their skills they perform or not some very easy work. 4 persons live in their family without any project.(ABSTRACT TRUNCATED AT 250 WORDS)

[Veno-venous extracorporeal oxygenation and veno-arterial extracorporeal oxygenation. Questions, answers]. / Assistance respiratoire veino-veineuse et assistance circulatoire veino-artérielle avec oxygénation extracorporelle. Questions, réponses.

A round table, organized by the French Society of Perfusion (Sofraperf) at the French national congress on extracorporeal circulations (Perfusion 2013), was attended by perfusionists, anaesthesiologists, intensivists and surgeons around the theme of respiratory veno-venous support and veno-arterial circulatory support with extracorporeal oxygenation in intensive care units. The debate was conducted in a participatory manner by bi-directional questions-answers session between moderators and assistance. The authors report management of this type of therapy that is not perfectly homogeneous, supported on literature data. Cannulae, cannulation, circuit, oxygenator, anticoagulation, control, surveillance, weaning are subject to paragraphs with defined entry whose contents are mutually enriching.