Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection.

OBJECTIVE: To evaluate the clinical impact of using a silver-releasing hydroalginate dressing to minimise the risk of local infection in colonised chronic wounds. METHOD: This was a randomised (stratification according to wound type) open-label multicentre comparative two-arm parallel-group study. Thirteen centres recruited 99 patients with either a venous leg ulcer or a pressure ulcer. None of the wounds required systemic antibiotics or were associated with lymphangitis and/or fever, but at least two of the following criteria had to be present: continuous pain; erythema; oedema; heat; and moderate to high levels of serous exudate. Patients were allocated to receive either a silver-releasing hydroalginate dressing (Silvercel, the test group) or a pure calcium alginate dressing (Algosteril, the control group). Wounds were assessed daily over 14 days to complete a modified ASEPSIS index to evaluate risk of infection, and then weekly for two additional weeks. A global wound severity score and area tracings were recorded weekly. RESULTS: Fifty-one and 48 patients were randomised in the test and control groups respectively: 28 pressure ulcers and 71 venous leg ulcers. The total mASEPSIS score over 14 days did not differ significantly between groups: 95.4 +/- 62.2 and 104.2 +/- 72.8 in control and test groups respectively (p = 0.791). Of the patients who completed the total four-week study duration, four out of 38 (10.5%) in the control group and none of the 40 in the test group were treated with systemic antibiotics at the final visit (p = 0.053). According to the investigators, fewer wounds developed a clinical infection over the four-week follow-up in the test group (33% versus 46%; p = 0.223). Overall, the four-week closure rate was statistically greater in the test group (0.32 +/- 0.57cm2/day versus 0.16 +/- 0.40cm2/day; p = 0.024). Compared with baseline, the absolute decrease in wound severity score at week four was higher in the test group (-5.6 +/- 3.2 versus -4.1 +/- 4.3; p = 0.063); this was also true of the percentage reduction (-32 +/- 17% versus -23 +/- 25%; p = 0.034). Poor dressing acceptability and/or tolerability was noted in five out of 48 patients (10.4%) in the control group and in five out of 51 (9.8%) in the test group. CONCLUSION: This study suggests that the use of silver-releasing dressings in the management of wounds at high risk of infection may have a clinically favourable influence on wound prognosis; the dressings also appeared to be well tolerated. However, the evaluation of these advantages in controlled clinical trials is complex and requires potent studies and the development of more specific endpoints than those currently used.

[Suicide and attempted suicide in the armed forces in 1998]. / Données épidémiologiques sur les suicides et tentatives de suicide dans les armées en 1998.

UNLABELLED: Little data exists concerning suicides and attempted suicides on professional duty. Now that the French Army is becoming professional, it is necessary to describe methods of self-destruction, in order to facilitate preventive measures. METHODS: The French Army operated a surveillance system to record all instances of suicide and attempted suicide. Under this surveillance system, all suicidal acts and attempts must be reported through an anonymous standard form completed by a military physician. This form records demographic data, the circumstances and known motives. For the epidemiological analysis, we used the chi square test and the Student test. A method of indirect standardization was employed to enable comparisons between military suicides and those within the general French population in 1996. We chose a risk of error of 5%. RESULTS: During the course of 1998, 145 forms were gathered for professional armed forces. Of these, 40 were recorded as actual suicides and 105 as attempted suicides. The suicide rate corresponded to 14p 100,000. Suicides were limited exclusively to males, the average age at death was 36. Comparisons with the French male population at large (using the indirect method of standardization) showed a standardized mortality rate of 0.43 (p > 0.05). Methods of self-destruction employed were mostly hanging and using firearms. Attempted suicide rate was 31.5 p 100,000, with a relatively even balance between males and females. The average age was 30. Methods of self-destruction employed were mostly drug ingestion and laceration. Difficulties with personal relationships were the principal motive recorded, whilst instances of psychiatric diseases were rare. Previous suicide attempts were known in 21% of recorded suicide attempts in 1998 and in 10% of actual suicide. There was no suicidal act during or linked to an outside army operation. The ratio suicide-attempted suicide was 0.38. DISCUSSION: The fact that the rate of suicide in the French Army is lower than the national average could be explained by the medical criteria used to select army personnel on active duty. These results should be interpreted with caution: our data only covers a single year. Moreover, there is a certain bias in the surveillance system used. Measures in the French Army to prevent suicide are based on a significant medical component within units, particularly during operational tours where there is sometimes a psychiatrist. Although the military physician is constrained by professional secrecy, he must execute his duty as an advisor to the commanding officer to signal human factors that need to be taken into account. Responsibility for knowing men and living conditions lies with the commanding officer. Epidemiological surveillance is a key element of analyzing the risks of suicidal. Its contributing role should be regularly reevaluated.

[Disclosure of a diagnosis of cancer: paradoxes and misunderstandings]. / L'annonce d'un diagnostic de cancer: paradoxes et quiproquos.

INTRODUCTION: Announcing to a patient that he has cancer is a key moment both in the relationship between this patient and his doctor and in the setting up of quality communications. However, the quality of this communication is often impaired by the presence of paradoxes and misunderstandings. CURRENT KNOWLEDGE AND KEY POINTS: The particularities of cancer, the defense mechanisms of the different contributors and cancer representations can increase the sources of misunderstandings, which will leave an indelible mark on the patient at the beginning of the disease. FUTURE AND PROJECTS: What's at stake in that type of announcement in terms of compliance should not be neglected. Practitioners becoming aware of those phenomena and communication rules should improve the modes of announcement.

Is male-infant caretaking related to paternity and/or mating activities in wild Barbary macaques (Macaca sylvanus)?

In species with a promiscuous mating system, the functions of male-infant caretaking remain unclear in the absence of genetic paternity tests. We tested paternal investment and hypotheses concerning reproductive tactics in wild groups of Barbary macaques, including results of genetic paternity tests. Our study revealed that male-infant caretaking was not related to the probability of paternity. In principle, males could use access to females to estimate paternity. However, we found that mating success was not related to paternity, so males could invest in infants that they had not sired, and caretaking of non-offspring was actually observed. Accordingly, males might be 'deceived' with respect to their paternal investment. In that case, one would expect a positive relation between mating success and the subsequent rate of male caretaking of infants. Such a relation is also lacking, leading to comprehensive rejection of the paternal investment hypothesis in Barbary macaques. By contrast, there was evidence that males showing infant care achieved higher mating frequencies than other males with the mothers of the relevant infants. Thus, male Barbary macaques do not show a 'mate-then-care' pattern, but they do exhibit a 'care-then-mate' pattern.

Simian immunodeficiency virus (SIV) from sun-tailed monkeys (Cercopithecus solatus): evidence for host-dependent evolution of SIV within the C. lhoesti superspecies.

Recently we reported the characterization of simian immunodeficiency virus (SIVlhoest) from a central African l'hoest monkey (Cercopithecus lhoesti lhoesti) that revealed a distant relationship to SIV isolated from a mandrill (SIVmnd). The present report describes a novel SIV (SIVsun) isolated from a healthy, wild-caught sun-tailed monkey (Cercopithecus lhoesti solatus), another member of the l'hoest superspecies. SIVsun replicated in a variety of human T-cell lines and in peripheral blood mononuclear cells of macaques (Macaca spp.) and patas monkeys (Erythrocebus patas). A full-length infectious clone of SIVsun was derived, and genetic analysis revealed that SIVsun was most closely related to SIVlhoest, with an amino acid identity of 71% in Gag, 73% in Pol, and 67% in Env. This degree of similarity is reminiscent of that observed between SIVagm isolates from vervet, grivet, and tantalus species of African green monkeys. The close relationship between SIVsun and SIVlhoest, despite their geographically distinct habitats, is consistent with evolution from a common ancestor, providing further evidence for the ancient nature of the primate lentivirus family. In addition, this observation leads us to suggest that the SIVmnd lineage should be designated the SIVlhoest lineage.

Behavioral responses of Barbary macaques (Macaca sylvanus) to variations in environmental conditions in Algeria.

In this study, the behavioral responses of Barbary macaques to seasonal and interhabitat variations in resource availability were analyzed over an entire annual cycle. Two groups, one in an evergreen cedar-oak forest (Djurdjura) and the other in a deciduous oak forest (Akfadou), were observed. In this paper, references to data on resource availability published elsewhere are made. Time budget has been studied. Variations in foraging and moving time, in day-range lengths, and in time moving in trees have been considered to estimate the variations in foraging effort and thus energy expenditure. Great monthly variations in foraging effort and other activities were observed in both habitats. In early spring, when resource availabilities were maximal, foraging effort was low while monkeys maximized their feeding time (about 5 h/day). In June, during the peak of the birth season and the rearing period, monkeys minimized their feeding time to the benefit of social interactions (to 1.6-2.7 h/day), whatever the food availability, which was low in Akfadou and high in Djurdjura. In addition, foraging effort remained low in Djurdjura, while it increased in Akfadou. Thus, at the beginning of the dry summer period, monkeys in Akfadou were in a less favorable position than those in Djurdjura. At both sites, in periods of food shortage in summer or in winter, monkeys displayed two different strategies. In the former case, their foraging effort increased, while in the second one it remained relatively low. Whatever the foraging effort, monkeys did not reach the same amount of feeding time as in early spring. In the poorest site of Akfadou, foraging effort was globally greater than in the richest site of Djurdjura, especially for adults. At both sites, adult males spent more time feeding than juveniles and less time in social interactions. Results are discussed according to rearing period, temperatures, and day length constraints. The limits of adaptability to different habitats are considered in light of the demographic parameters.

Aphakia correction by synthetic intracorneal implantation: a new tool for quantitative predetermination of the optical quality.

To improve the a priori estimation of optical quality of synthetic intracorneal implantation, numerical calculations were performed involving the intraocular overpressure, the cleavage depth and the type of the implant. Optical correction ratios, that were determined, are in close agreement with the obtained mechanical effects.

[Demand for care in traumatic war neuroses]. / La demande de soins dans les "névroses traumatiques de guerre".

Psychiatrists who must take care of patients suffering of Post Traumatic Stress Disorders are often surprised in front of the strength of repetition of the related frightful experience. Therapeutics methods which are more often used (Abreaction and Narcissism reconstruction by varied technics) have showed their limits. Leaning on their experience and referring to psycho-analytic teaching, the authors show the interest of the individual psychotherapy. They propose not to be strongly affected by the massive aspect to the "trauma" and to permit as far as possible the installation of the transfer.

[Demography and reproduction of Macaca sylvanus in different habitats in Algeria]. / Démographie et reproduction de Macaca sylvanus dans différents habitats en Algérie.

Usually described as a cedar forest monkey, the Barbary macaque in effect has colonized a great variety of habitat types. At the moment, it is not known to what extent these different habitats are suitable for the species' survival. We tried to answer this question by comparing the demography of three monkey troops: one lives in a deciduous oak forest; the second lives in an nondeciduous cedar-green oak forest while the third is found on rocky ridges of mountains without any arborescent vegetation. In the three sites, there is a true seasonal breeding season with most births taking place in April to May and most matings occurring in November to December. Details are given on reproduction parameters (sexual activity of females; fertility rates; young survival...). Monkeys densities are higher in cedar forest than in deciduous forest. The smallest density is found on mountain ridges. Forest troops are more numerous, highly stable; their growth rate is better and the population is relatively young. The situation is slightly better still in the cedar forest than in the oak forest with a sex ratio more in favor of females and a better survival of the young. The troop of the mountain ridges is an unstable group ranging from 10 to 25 individuals; the population is aging, with a low birth rate and more male infants surviving compared with females. Demographic differences between sites are discussed according to climate, food availability and human influences (tree-clearing and overgrazing). Conclusions are drawn from this situation, for species conservation.

[Adjuvant chemotherapy of cancer of the ovary]. / La chimiothérapie adjuvante des cancers de l'ovaire.

The aim of adjuvant chemotherapy is to cure micrometastatic disease and to prevent relapses after apparently complete surgical exeresis. It is almost always administered after initial surgical treatment, except for stage IA1 malignant epithelial tumours and stage I-II pur dysgerminomas. Chemotherapy combines anthracycline, an alkylating agent, a plant alkaloid and cis-platinum, for 4-8 months. After second-look laparotomy, if no more macro or microscopic tumor have been discovered, adjuvant chemotherapy does not seem necessary. However it is when all residual tumor has been excised or cyto- and/or histologic controls are positive. Optimal schedules are not yet perfectly defined. In some cases, a third look laparotomy should confirm the absence of tumor in order to stop treatment. Side effects (hematologic, gastrointestinal, neurologic, renal) are frequent. It is necessary to recognize patients able to benefit from chemotherapy and to define the least toxic treatment.

[Carcinoma in situ of the uterine cervix. Experience of the Centre Oscar Labret of Lille (author's transl)]. / L'épithélioma intra-épithélial du col utérin. Expérience du Centre Oscar Lambret de Lille.

Forty cases of carcinoma in situ of the cervix were seen in the "Center Oscar Labret" of Lille between 1953 and 1978. The best treatment appears to be only simple total hysterectomy. Twenty patients underwent such an operation. seven In the course attended of follow-up, among 36 patients who regularly the out-patient clinic, there was one case of persistent progression and one early vaginal recurrence of the carcinoma in situ.

[Determination of global diffusion of CO2 and its partial components under assisted respiration. Technical problems and practical value in respiratory resuscitation]. / Détermination sous ventilation assistée de la ductance globale du CO2 et de ses composantes partielles. Problèmes techniques et intérêt pratique en réanimation respiratoire.

A study of partial CO2 ductance has been performed in patients under assisted ventilation. The authors propose methods for simultaneous measurement of paCO2, PAECO2, PECO2 and PICO2. This methodology is used in patients presenting different conditions accounting for respiratory resuscitation: barbiturate poisoning with healthy lungs, bronchial stasis, acute lung involvement, obstructive bronchopneumopathy and pulmonary embolism.