[Impact of partial nephrectomy in a hybrid operating room on the activity of kidney cancer surgery]. / Évaluation de l'utilisation de la salle hybride sur l'activité de chirurgie en cancérologie rénale.

INTRODUCTION: Partial nephrectomy (NP) after embolization of tumor vessels (NPESH) in a hybrid room combines embolization of tumor vessels and enucleation of the tumor under laparoscopy in the same operative time. The purpose of this study was to assess the impact of the use of NPESH in the management of patients treated with surgery for a localized kidney tumor. MATERIAL AND METHODS: Using the uroCCR database, we included all consecutive patients operated in a university hospital for localized kidney tumor. From 2011 to May 2015, patients were treated by Standard Partial Nephrectomy (NPS) Laparoscopic or Open and from May 2015 to May 2019 by NPESH. We evaluated characteristics of patients, tumors, perioperative data and complications. These data were compared by Student and Khi2 tests. RESULTS: 87 NPS were performed during Period 1 and 137 NPS were performed during period 2. The ASA score of patients undergoing NPESH was higher than NPS (P<0.0001). The tumor complexity and median tumor size were similar in the two groups (P=0.852 and P=0.48). The complication rate for NPS and NPESH was 55.2% and 33.6% (P=0.002). There were less severe complications in the NEPSH group (P=0.012). The median length of stay was 8 and 4 days for the NPS and NPESH groups (P<0.0001). Positive surgical margins were 2 (2.3%) and 6 (4.6%) for the NPS and NPESH group (P=0.713). DISCUSSION: NPESH is an efficient technique compared to NPS. It seems to be an interesting alternative to limit renal ischemia, complication rate and length of stay for the management of localized kidney tumors.

Volvulus of the appendix secondary to appendicular mucocele.

A 44-year-old woman presented with appendicular volvulus secondary to an appendicular mucocele. Appendicular volvulus symptomatology is similar to that of acute appendicitis. Diagnosis is often interoperative. In the event of secondary volvulus, surgical procedure addresses the underlying pathology; in our case, it consisted in appendicectomy and mesoappendix resection.

[Attempted suicide by firearms: a retrospective study of 161 cases]. / Conduites suicidaires au moyen d'une arme à feu : étude clinique à partir de 161 cas.

OBJECTIVES: To determine the specific clinical aspects of patients with suicidal behaviour by firearm and investigate the specificities of the suicide method. BACKGROUND: Suicidal behaviour represents a major public health problem throughout the world. Attempted suicide and completed suicide by firearms rates are very high both in Europe and in the United States. Preventive aspects presently preoccupy the physicians and the politicians. However, methods of suicide are understudied in Europe for the benefit of psychopathological and epidemiological aspects of suicide. Only a minority of studies enquire into the clinical aspects according to the method of suicide. Nevertheless, most of the international studies have already demonstrated the efficacy of reducing the accessibility of weapons. METHODS: A retrospective study including suicide attempters by firearm hospitalized in the general hospital of Poitiers between 1992 and 2005. RESULTS: We included 161 patients with self-inflicted gunshot wounds, among which 88% of patients were males. Most of them did not live alone and had children. Some of them had a past history of attempted suicide, some of them using a violent method. The acting out has mostly been committed at home and the firearm used was frequently a hunting gun. Interpersonal conflicts have been mostly reported by the patient with self-inflicted gunshot wounds. The prevalence of alcoholic behaviour and major depression is very important. Personality disorders are overrepresented in the study, notably paranoiac and borderline disorders. DISCUSSION: Our sample is one of the largest compared to the other studies that often did not exceed 30 patients. Some results are contrary to those of populations of suicide attempters, whereas there are some similarities within the completed suicide population. Finally, paranoiac personality disorder is significantly associated with suicidal behaviour by firearm. CONCLUSIONS: Some clinical characteristics have been reported as far as suicide attempters by firearm are concerned. Actually, there are some significant differences between suicide attempters by firearm and other suicide attempters. These results are very important for the perspective of preventing suicidal behaviour. However, it is essential to continue studies on the clinical aspects according to the method used in attempted and completed suicide.

[Home telemonitoring of CPAP: a feasibility study]. / La télé-observance à domicile de la pression positive continue: étude de faisabilité.

BACKGROUND: The most commonly used treatment for the sleep apnoea syndrome (SAS) is the application of constant positive airway pressure (CPAP) during sleep. Compliance is an essential element in the efficiency of CPAP. This is dependent on the quality of the management of care and on the education of the patients. With the emergence of telemedicine, telemonitoring of CPAP has been developed in France. METHODS: This study will be observational and multicentered. The main aim is to evaluate the feasibility of CPAP telemonitoring in SAS patients (n=90). During the installation of the equipment, the patients will be instructed how to connect the CPAP Secure Digital card to a data transmitting box every week for two months. The actual number and frequency of remote-monitoring box connections will be recorded. The data transmission will be made to the study coordinator, the home care provider SADIR, by the way of a telemedicine platform, located in France. EXPECTED RESULTS: This study will allow measurement of the adherence of the patients to their CPAP treatment by telemonitoring using this new tool of data transmission and the impact of this on CPAP compliance.