Feasibility and Safety of Active Physiotherapy in the Intensive Care Unit for Intubated Patients with Malignancy.

OBJECTIVES: Physiotherapy leads to improvements in critically ill patients who receive mechanical ventilation. However, cancer patients have not been included in previous studies on this subject. This study explored the feasibility and safety of physiotherapy in the intensive care unit for patients with malignancy. DESIGN: Observational prospective single-centre study, comparing cancer and control patients. PATIENTS: All consecutive patients admitted to the intensive care unit who needed invasive mechanical ventilation for more than 2 days with no contraindication to physiotherapy were included in the study. METHODS: The main outcome was the proportion of physiotherapy sessions at the prescribed level in each group. RESULTS: A total of 60 patients were included within 1 year. A total of 576 days were screened for physiotherapy sessions and 367 physiotherapy-days were analysed (137 days for control patients and 230 days for cancer patients). The ratio of physiotherapy sessions performed/prescribed did not differ between groups: 0.78 (0.47-1) in the control group vs 0.69 (0.6-1) in the cancer group (odds ratio 1.18 (IC95% 0.74-1.89); p = 0.23). A sensitivity analysis including patient effect as random variable confirmed those results (odds ratio 1.16 (0.56-2.38), p = 0.69). Adverse events occurred with the same frequency in cancer patients and non-cancer patients. CONCLUSION: Physiotherapy in cancer patients who require intubation is feasible and safe. However, only two-thirds of prescribed physiotherapy sessions were performed. Studies are warranted to explore the barriers to physiotherapy in the intensive care unit setting.

Percutaneous ablation of obscure hypovascular liver tumours in challenging locations using arterial CT-portography guidance.

PURPOSE: The purpose of this study was to evaluate the feasibility, safety and efficacy of percutaneous ablation (PA) of obscure hypovascular liver tumors in challenging locations using arterial CT-portography (ACP) guidance. MATERIALS AND METHODS: A total of 26 patients with a total of 28 obscure, hypovascular malignant liver tumors were included. There were 18 men and 6 women with a mean age of 58±14 (SD) years (range: 37-75 years). The tumors had a mean diameter of 14±10 (SD) mm (range: 7-24mm) and were intrahepatic cholangiocarcinoma (4/28; 14%), liver metastases from colon cancer (18/28; 64%), corticosurrenaloma (3/28; 11%) or liver metastases from breast cancer (3/28; 11%). All tumors were in challenging locations including subcapsular (14/28; 50%), liver dome (9/28; 32%) or perihilar (5/28; 18%) locations. A total of 28 PA (12 radiofrequency ablations, 11 microwave ablations and 5 irreversible electroporations) procedures were performed under ACP guidance. RESULTS: A total of 67 needles [mean: 2.5±1.5 (SD); range: 1-5] were inserted under ACP guidance, with a 100% technical success rate for PA. Median total effective dose was 26.5 mSv (IQR: 19.1, 32.2 mSv). Two complications were encountered (pneumothorax; one abscess both with full recovery), yielding a complication rate of 7%. No significant change in mean creatinine clearance was observed (80.5mL/min at baseline and 85.3mL/min at day 7; P=0.8). Post-treatment evaluation of the ablation zone was overestimated on ACP compared with conventional CT examination in 3/28 tumors (11%). After a median follow-up of 20 months (range: 12-35 months), local tumor progression was observed in 2/28 tumours (7%). CONCLUSION: ACP guidance is feasible and allows safe and effective PA of obscure hypo-attenuating liver tumors in challenging locations without damaging the renal function and with acceptable radiation exposure. Post-treatment assessment should be performed using conventional CT or MRI to avoid size overestimation of the ablation zone.

Mental health capacity building in refugee primary health care settings in Sub-Saharan Africa: impact, challenges and gaps.

BACKGROUND: In 2015, the United Nations High Commissioner for Refugees started a process of mental health capacity building in refugee primary health care settings in seven countries in Sub-Saharan Africa, ultimately aiming to decrease the treatment gap of mental, neurological and substance use (MNS) conditions in these operations. In 2015 and 2016, a specialized non-governmental organization, the War Trauma Foundation, trained 619 staff with the mental health gap action programme (mhGAP) Humanitarian Intervention Guide (HIG), a tool designed to guide clinical decision making in humanitarian settings. METHODS: This paper describes the results of a process evaluation of a real-life implementation project by an external consultant, one and a half years after starting the programme. RESULTS: The mhGAP-HIG capacity building efforts had various effects contributing to the integration of mental health in refugee primary health care. Facility-and community-based staff reported strengthened capacities to deliver mental health and psychosocial support interventions as well as changes in their attitude towards people suffering from MNS conditions. Service delivery and collaboration amongst different intervention levels improved. The scarcity of specialized staff in these settings was a major barrier, hindering the setting-up of supervision mechanisms. CONCLUSION: Mental health training of non-specialized staff in complex humanitarian settings is feasible and can lead to increased competency of providers. However, capacity building is a 'process' and not an 'event' and mhGAP trainings are only one element in a spectrum of activities aimed at integrating mental health into general health care. Regular supervision and continuing on-the-job training are in fact critical to ensure sustainability.

[Disseminated cutaneous and visceral fusariosis in an aplastic patient: an unusual digestive entry]. / Fusariose cutanée et viscérale disséminée chez un malade en aplasie: une porte d'entrée digestive inhabituelle.

INTRODUCTION: The hyalohyphomycetes, Fusarium spp, are very common in our environment. Some of them have been recognized as being opportunistic agents responsible for localized as well as generalized infections, especially in the case of malignant blood diseases. Their poor sensitivity to standard antifungal therapeutics makes them very dangerous. We report a case of cutaneous and systemic fusariosis due to Fusarium moniliforme in a patient with acute lymphoblastic leukemia. CASE-REPORT: A 20 year-old male student was suffering from acute type 6 myeloblastic leukemia. During the second consolidation schedule with a combined therapy of aracytine and amsacrine, this patient whose food diet was exclusively based on cereals, showed evidence of febrile aplasia, associated with myalgia, abdominal pain and diarrhoea. Microbiological samples were sterile. Ten days later, we noted the appearance of painful, diffuse and purple dermohypodermal cutaneous nodules surrounded by an erythematous ring. Histological and microbiological examination of the hypodermis biopsies of the skin nodules revealed invasion by Fusarium moniliforme. Treatment with voriconazole in association with transfusions of leukocytes led to clinical and microbiological cure. DISCUSSION: In our case report, the clinical pattern starting with digestive symptoms suggested dissemination from a digestive site, which is very unusual in Europe. In our patient, the malnutrition, together with a diet exclusively based on contaminated cereals in a context of malignant hemopathy, resulted in the colonization of the digestive tract by these moulds and the aplasia-inducing chemotherapy schedules enhanced their pathogen potential.

Diminished bactericidal activity in megalocytic interstitial nephritis.

The first case of favorable evolution under conservative treatment for acute renal failure caused by megalocytic interstitial nephritis and the ongoing transitory impairment of the polymorphonuclear bactericidal ability are described. This case report has been included in a critical overview of the cases previously reported.

[Association of IgA linear dermatitis and non-Hodgkin's malignant lymphoma]. / Association d'une dermatose à IgA linéaire et d'un lymphome malin non hodgkinien.

The association between linear IgA dermatosis and neoplasia has been the subject of several publications which suggest that the association is not fortuitous. We report a new case in which a non-Hodgkin's lymphoma was associated with a linear IgA dermatosis and underline the need for full evaluation in search of an associated neoplasia. However, the neoplasia-LAD association is not a true paraneoplastic syndrome since the two pathologies seldom follow a parallel course.

[Rhabdomyosarcoma of the thoracic wall in an adult. Apropos of a case]. / Rhabdomyosarcome de la paroi thoracique chez un adulte. A propos d'un cas.

Rhabdomyosarcoma is a malignant tumour generally observed in children or adolescents; thoracic localization is rare. The authors report a case of embryonary rhabdomyosarcoma of the thoracic wall in a 36-year-old subject. Pathology examination of surgical specimens confirmed the diagnosis. Treatment included surgical exeresis together with pre- and post-operative chemotherapy combining doxorubicine (40 mg/m2/cycle), ifosfamide (6 g/m2/cycle) and dacarbazine (900 mg/m2/cycle). Local recurrence, requiring radiotherapy, was observed a few months later and led to the patient's death after a 9-month clinical course.