[Study on how schizophrenic patients perceive treatment with injections in the deltoid muscle]. / Étude sur la perception du traitement injectable dans le muscle deltoïde par les patients souffrant de troubles schizophréniques.

UNLABELLED: Despite the advantages of antipsychotic treatments via the injectable route of administration, there are still reservations regarding this type of therapy, notably among health professionals. A survey conducted with patients suffering from schizophrenic disorders revealed the positive opinion that they had of their treatment. Another survey showed that nearly half of the patients preferred an injectable form, and two thirds felt they were cared for better, because of the injectable treatment. The slow release form of risperidone allows a choice between two injection sites: the deltoid muscle or the gluteal muscle. A recent study showed the satisfaction of the health professionals towards this novel form. The survey presented here was aimed at collecting the opinion of patients regarding the possibility of choosing the injection site, and the changes it would make. OBJECTIVES AND METHODS: The survey was carried out by the BVA Institute during the first half of 2011. The interviews with the schizophrenic patients, followed-up as out patients and treated with long lasting antipsychotics (n=281), were conducted face to face at the hospital by BVA interviewers specialised in the field of health, without the presence of any health professionals. A total of 32 centres participated in the survey; 38% of the interviews took place in the Paris area and 62% in various regions. RESULTS: Different dimensions were analysed. (1) The perception of injectable treatment was largely positive: among all the patients, 75% claimed they currently felt better once they had started the injectable treatment. (2) The choice of the injection site appeared important to a majority of patients (70% of the total sample; 79% of patients had experienced both sites of injection), 56% claimed that it was legitimate that they be given the choice and they felt that they were thus able to participate in their treatment (58%), their treatment was more acceptable (54%), and they found that their relationship with the doctor or nurse was enhanced (53%). (3) The preference regarding the injection site went to the deltoid muscle, among those who had experienced both sites. (4) The perception of the injection sites confirms this preference, the positive qualifications often being associated with the deltoid site, and the negative qualifications with the gluteal site. CONCLUSION: The survey presented here could contribute in convincing the health professionals to propose the choice to patients between the two injection sites in order to improve their compliance to treatment. Patients would therefore play a role in the choice of their treatment and hence become more involved in the follow-up.

[Quality & Safety in radiotherapy: advocacy for a professional strategy]. / Qualité - sécurité en radiothérapie: pour une stratégie professionnelle.

In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Epinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement.

Road mobility and the risk of road traffic accident as a driver. The impact of medical conditions and life events.

STUDY OBJECTIVE: We conducted a longitudinal investigation of the impact of self-reported life events and medical conditions on changes in road mobility on the wheel between 2000 and 2002 in order to assess whether these changes would affect the risk of road traffic accident (RTA). METHODS: Data are from a cohort of workers and retirees from the French national gas and electricity companies (the Gazel cohort). In the present study, 10,483 participants were included (7843 men aged 51-61 years and 2640 women aged 46-61 years, in 2000). The link between mobility and the risk of RTA was approximated using data on RTA number during lifetime and reported mobility in 2000. We then compared changes in road mobility between 2000 and 2002 resulting from life events and medical conditions reported to have occurred in the year 2001 or changed when compared to year 2000. We also compared road mobilities in 2000 in order to assess any pre-existing differences before life events and medical conditions. This led to estimation of the effect of road mobility changes on the risk of RTA. RESULTS: Changes in road mobility associated with life events and medical conditions were only found among men. These changes in road mobility were minimal. Ensuing changes in the risk of RTA were estimated to be small (odds-ratios ranged from 0.94 to 1.01). The only life events found to be associated with increased road mobility was an important purchase. Hospitalization, serious RTA, and retiring were associated with reduced road mobility. Concerning medical conditions, men who reported cataract, angina pectoris, diabetes, anxiety and stress, sleep disorder, and depression decreased their road mobility. CONCLUSION: We found no or moderate changes in road mobility resulting from life events and medical conditions, suggesting that results from previous published studies that assessed the impact of life events or medical conditions on RTA were not jeopardized by improper adjustment for road mobility.

Selective activity of several cholic acid derivatives against human immunodeficiency virus replication in vitro.

Several cholic acid derivatives such as taurolithocholic acid, lithocholic acid 3-sulfate, taurolithocholic acid 3-sulfate, and glycolithocholic acid 3-sulfate were shown to inhibit selectively the replication of human immunodeficiency virus type 1 (HIV-1) in vitro. These compounds completely protected MT-4 cells against HIV-1-induced cytopathogenicity at a concentration of 100 micrograms/ml, whereas no toxicity for the host cells was observed at 200 micrograms/ml. They also inhibited HIV-1 antigen expression in HIV-1-infected CEM cells. The bile acids (cholic acid, deoxycholic acid, chenodeoxycholic acid, and lithocholic acid) did not show any inhibitory effect on HIV-1 replication at concentrations that were not toxic to the host (MT-4) cells. From a structure-function analysis of a number of cholic acid derivatives, the presence of either a sulfonate (as in the tauro conjugates) or a sulfate group as well as the "litho" configuration appeared to be necessary for the expression of anti-HIV-1 activity. The active cholic acid derivatives did not directly inactivate the virus particles at the concentrations that were not toxic to the host cells. Lithocholic acid 3-sulfate, taurolithocholic acid 3-sulfate, and glycolithocholic acid 3-sulfate, but not taurolithocholic acid, partially inhibited virus adsorption to MT-4 cells. These three compounds were also inhibitory to the reverse transcriptase activity associated with HIV-1.

Synthesis of the specific monosulfates of cholic acid.

The three isomeric cholic acid-monosulfates were synthetized and characterized. Cholic acid-3-sulfate was obtained by reacting cholic acid for 2 min with chlorosulfonic acid in pyridine and chromatography of the resulting bile salt mixture on Sephadex LH-20. The 7- and the 12-monosulfate were prepared by sulfation of the corresponding monohydroxy-diacetates followed by removal of the acetyl groups by alkaline hydrolysis and purification by chromatography on Sephadex LH-20. On TLC in n-butanol-acetic acid-water (10:1:1, v/v) the Rf values were 0.59 for cholic acid-3-sulfate, 0.52 for cholic acid-7-sulfate and 0.48 for cholic acid-12-sulfate. The time required for complete solvolysis at 37 degrees C in acid methanol-acetone (1:9) was 3 h for cholic acid-3-sulfate, 12 h for the 12-monosulfate and 18 h for the 7-monosulfate.

A further study of the bile acids in infants with coprostanic acidemia.

The structure of the bile acids in serum of infants with coprostanic acidemia was further investigated. The identity of 3 alpha-hydroxy-5 beta-cholestan-26-oic acid and 3 beta-hydroxy-5-cholesten-26-oic acid was confirmed. The biosynthesis of the 3 alpha, 7 alpha, 12 alpha-trihydroxy-5 beta-C29 dicarboxylic bile acid does not start from beta-sitosterol.

Synthesis and characteristics of the specific monosulfates of chenodeoxycholate, deoxycholate and their taurine or glycine conjugates.

The isomeric monosulfates of chenodeoxycholate, deoxycholate, and their taurine or glycine conjugates, were synthesized and characterized. Reaction with chlorosulfonic acid in pyridine for 2 minutes mainly afforded the 3-monosulfates. To prepare the 7- or the 12-monosulfates, the 3-hydroxyl group was protected by carbethoxylation prior to sulfation of the 7- or 12-hydroxyl group for 24 h to 5 days; after sulfation, the protecting 3-carbethoxy function was removed by mild alkaline hydrolysis. The crude bile salt monosulfates were purified by chromatography on silica gel and on Sephadex LH-20 and were crystallized from methanolethanol-ethyl acetate. The results of elemental analysis demonstrated that the compounds were disodium dihydroxy bile salt monosulfates. Thin layer chromatography of the sulfates, and gas-liquid chromatography after oxidation and solvolysis, showed that the substances were pure and that the sulfate group was at the expected position.

By-products in the analysis of beta-muricholic acid in biological samples as methyl ester triacetate.

By-products were formed on analysis of beta-muricholic acid (3 alpha, 6 beta, 7 beta-trihydroxy-5 beta-cholan-24-oic acid) in biological samples by a method involving acid-catalyzed solvolysis of sulfate esters in acetone-methanol, followed by perchloric acid-catalyzed acetylation with acetic anhydride-acetic acid. These products have been identified by mass spectrometry and nuclear magnetic resonance as methyl 3-0,6-0-diacetyl-7-0-(1-methyl-3-oxo-1-butenyl)- and methyl 3-0,7-0-diacetyl-6-0-(1-methyl-3-oxo-1-butenyl)-beta-muricholate, methyl 3-0, 6-0-diacetyl- and methyl 3-0, 7-0-diacetyl-beta-muricholate, and a methyl diacetoxy-cholen-24-oate.

Synthesis and 29-14C-labeling of 3 alpha, 7 alpha, 12 alpha-trihydroxy-27-carboxymethyl-5 beta-cholestan-26-oic acid. A bile acid occurring in peroxisomal diseases.

The synthesis and 14C-labeling of 3 alpha, 7 alpha, 12 alpha-trihydroxy-27-carboxymethyl-5 beta-cholestan-26-oic acid by two different approaches is described. One of them involves chain elongation of cholic acid via Wittig-Horner condensation of its formylated 24-aldehyde with tetraethyl phosphonoglutarate. The resulting cholestenoate, on deprotection and hydrogenation, affords the unusual C29 bile acid in good yield. An alternative procedure consists in a malonic ester synthesis starting from the formylated 24-alcohol which, after conversion into a mesylate, is reacted with sodium salt of 2-carboethoxy-gamma-butyrolactone. Alkaline hydrolysis, decarboxylation, esterification with diazomethane and selective tosylation of the newly introduced primary hydroxyl function give a C28 precursor, which is easily chain-elongated into a labeled or unlabeled C29 bile acid by reaction with cyanide and hydrolysis. Due to the easy lactonization of some of the C28 intermediates, the latter method provides a better way for introducing a C-29 label than the sequence usually employed for carboxyl labeling of bile acids and consisting in a decarboxylative halogenation of the parent acid followed by substitution of the norhalogenide with [14C]cyanide and hydrolysis. The structure of the synthesized acid or its dimethyl ester is confirmed by 13C nuclear magnetic resonance spectroscopy and mass spectrometry, and is also shown by gas liquid chromatography to be identified with an authentic sample of biosynthetic C29 dioic bile acid extracted from body fluids of Zellweger patients.

[Digestive hemorrhage caused by congestive gastropathy in a patient with liver cirrhosis: emergency treatment by transjugular intrahepatic portosystemic anastomosis]. / Hémorragie digestive par gastropathie congestive chez un malade atteint de cirrhose: traitement en urgence par anastomose porto-systémique intra-hépatique transjugulaire.

A 34-year-old woman with liver cirrhosis and portal hypertension was admitted for gastric bleeding due to congestive gastropathy. Her past medical history included 4 episodes of variceal rupture within the last 5 months. As medical treatment was a failure, an emergency transjugular intrahepatic portosystemic shunt was successfully performed, resulting in a marked drop in portal pressure (from 32 to 15 mm Hg) and a subsequent arrest of acute hemorrhage. Four months later, no recurrent bleeding has been observed and the shunt has remained patent as documented by duplex Doppler sonography.

[Budd-Chiari syndrome with thrombosis of the inferior vena cava. Treatment by mesenterico-innominate shunt]. / Syndrome de Budd-Chiari avec thrombose de la veine cave inférieure. Traitement par une dérivation mésentérico-innominée.

We report two cases of patients, 12 and 28 years old, suffering from a Budd-Chiari syndrome with a thrombosed inferior vena cava, who were treated by a shunt interposed between the superior mesenteric vein and the left innominate vein. The aim of this shunt was to avoid pericardiotomy in these patients with peroperative ascites, in order to reduce the risk of pericarditis after surgery. A reinforced polytetrafluoroethylene prosthesis (Gore-Tex) was used, associated with an interposition jugular vein graft in the 12-year old child, alone in the other case. The left innominate vein was isolated through a midline sternotomy, and the prosthesis was placed in a retrosternal position. Operation and postoperative course were uneventful. All signs of ascites disappeared. The patients were free of symptoms, 8 and 4 months after surgery respectively. Shunt patency was documented by angiography and magnetic nuclear resonance.

[Heparin-induced thrombopenia. Vascular complications in six cases (author's transl)]. / La thrombopénie induite par l'héparine. A propos de six cas et de leurs complications vasculaires.

The most frequent complication during heparin treatment is hemorrhage from overdosage. Heparin-induced thrombopenia is more rarely observed but is a more serious disorder. Six such cases are reported, of which three were complicated by gangrene of the limbs. Clinical findings are described, together with the methods of detecting the presence of heparin-induced antiplatelet antibodies. The affection becomes evident on the 9th day of treatment by the presence of a thrombopenia and accompanying clinical signs. These may be those of a hemorrhagic syndrome directly related to the thrombopenia, or manifestations of thrombotic lesions. The latter can cause worsening of the condition for which heparin was prescribed, arterial thrombosis of a large vessel, venous thromboses disappearing after interruption of heparin treatment, of distal thrombosis of the microcirculation with a rapidly irreversible onset of gangrene requiring amputation. The lesions are provoked by an immune mechanism and heparin has to be discontinued.

Hearing Protection in the Military Environment.

The present state of passive (linear and non-linear) and active techniques for hearing protection in the military environment is reviewed. Solutions which allow to protect the ear from large continuous and high-level impulse noises while preserving the operational abilities of the personnel (detection, localisation, communication.) are emphasised.

A quantitative risk analysis tool for design/simulation of wastewater treatment plants.

Uncertainty is a central concept in the decision-making process, especially when dealing with biological systems subject to large natural variations. In the design of activated sludge systems, a conventional approach in dealing with uncertainty is implicitly translating it into above-normal safety factors, which in some cases may even increase the capital investments by an order of magnitude. To obviate this problem, an alternative design approach explicitly incorporating uncertainty is herein proposed. A probabilistic Monte Carlo engine is coupled to deterministic wastewater treatment plant (WWTP) models. The paper provides a description of the approach and a demonstration of the general adequacy of the method. The procedure is examined in an upgrade of a conventional WWTP towards stricter effluent standards on nutrients. The results suggest that the procedure can support the decision-making process under uncertainty conditions and that it can enhance the likelihood of meeting effluent standards without entailing above-normal capital investments. The analysis led to reducing the capital investment by 43%, producing savings of more than 1.2 million euro.

[Peridural anesthesia with procaine and fentanyl in a parturient with acute intermittent porphyria]. / Analgésie péridurale par procaïne et fentanyl chez une parturiente atteinte de porphyrie aiguë intermittente.

Acute intermittent porphyria is one of three severe hepatic porphyrias. Clinical manifestations include intermittent acute attacks of abdominal pain and neuropathy with an occasionally outcome. These attacks are often precipitated by endogenous (menstrual cycle and pregnancy in women) or exogenous factors (porphyrinogenic drugs). An epidural analgesia was performed during the labour of a pregnant woman with acute intermittent porphyria just after an acute attack of abdominal pain. Analgesia was obtained using procaine and fentanyl. The choice of drugs was based on available clinical reports and experimental studies of the porphyrinogenicity of drugs in animal models (rat in vivo and chick embryo in ovo).

[Esophageal perforation during tracheal intubation. Report on 6 cases. (author's transl)]. / Perforation de l'oesophage au cours d'intubations trachéales. A propos de 6 cas.

Perforation of the esophagus and hypopharynx followed tracheal intubation for general anesthesia or during intensive care in 6 patients. Circumstances favorable to the production of these lesions, and diagnostic features enabling early diagnosis are discussed. Simple surgical procedures and intensive postoperative care resulted in recovery in 5 of the 6 cases.

[The concept of ambulatory surgery]. / Le concept de chirurgie ambulatoire.

Ambulatory surgery is a concept of organization, organization centered on the patient. It is an innovation whose development depends on policies of accompaniment that are devoted to it. As for all innovation the patients or the society can't profit of its benefits if its conditions are not respected. Recognized international definitions all insist on its qualified character and on its substitution effect.

[In the year 2000, are there still anesthesiologic contraindications for laparoscopic abdominal surgery?]. / Reste-t-il en l'an 2000 des contre-indications anesthésiques à la chirurgie abdominale par laparoscopie?

Indications for laparoscopic surgery have been extended in the last ten years. Patients with several organ failures may also benefit of such technique. Therefore, it seems interesting to study and analyse the interactions between clinical status and the consequences of intra-abdominal gas insufflation. Because the postoperative benefits of laparoscopic surgery are notable, this technique is more and more proposed to old patients. The only imperative is to anticipate medical problems.

[Cervical esophagus injuries (author's transl)]. / Traumatismes de l'oesophage cervical.

The authors report 16 cases of cervical esophagus injuries. In two patients, they followed a closed injury to the neck, in six cases, wounds from firearms or other weapons. In five cases, tracheal intubation, and in three cases, perforations of various origins. All patients required operative treatment, and in six cases surgery was performed between the 3rd and 25th day following the injury. Only one of the 8 patients operated upon within 12 hours following injury developed cervicomediastinal complications, while seven of the 8 cases operated upon after this period developed mediastinitis or a fistula. Radiological examination with an opaque medium and urgent operation combining drainage and suture are essential when injury to the esophagus is suspected, in order to obtain early diagnosis and good results.

[The abdomen in multiple-injured patients. Comparative study on 225 multiple-injured patients with and without abdominal lesions. Incidence of abdominal complications]. / L'abdomen du polytraumatisé. Etude comparative portant sur 225 polytraumatisés avec et sans lésions abdominales. Incidence des complications abdominales.

Of 225 patients with multiple injuries and a high lesional score, 100 presented traumatic abdominal lesions. Comparison of the two groups confirmed both the usefulness and validity of a traumatic index and the reliability of abdominal puncture-lavage. Abdominal complications were analyzed. Mortality in all multiple injury cases, with or without abdominal lesions, was identical in this series where emergency surgery was performed only for lesions affecting vital organs, the mean age of patients with abdominal lesion being significantly lower. An attitude to adopt when deciding whether surgery is necessary is proposed.