[Comparative study about enhanced recovery after cesarean section: What benefits, what risks?] / Étude comparative sur la réhabilitation améliorée postcésarienne : quels bénéfices, quels risques ?

OBJECTIVE: The post-caesarean enhanced recovery protocol's goal is to allow a quick recovery of previous physical capabilities and increase the chances of an early release and return to normal activities. METHODS: At the Foch Hospital, we performed a case control survey including 2 consecutive groups of patients. The first group was composed of 83 patients that experienced the regular post c-section treatment and the second group of 84 patients that benefited from the enhanced recovery treatment. The characteristics of both groups were comparable. We monitored the complications, hospitalization time and full recovery time for each group. RESULTS: The average hospitalisation time for the patients that received the enhanced recovery treatment was significantly lower than for those that received the standard treatment (3,92 days vs 4,34 days P<0,01). The autonomy for the toilet and the mobility was improved. The average number of complications was not greater for the enhanced recovery group, except for acute retention of urine which were all treated with a simple urine sample return. CONCLUSION: The post-cesarean enhanced recovery seams to allow the significant improvement in recovery of autonomy and length of hospitalization stay without increasing significantly the rate of complications except for the acute retentions of urines which involve in postpartum period close monitoring patients' urination.

Single-blind clinical trial comparing use of fentiazac and paracetamol in postendodontic periodontitis.

The efficacy of oral fentiazac (100 mg QID) was compared with that of paracetamol (500 mg QID) in a single-blind trial in 30 patients suffering from post-endodontic periodontitis secondary to infiltrative or abscessed pulpitis. Patients were allocated at random to two treatment groups and treated for four days. Over each of the four days, patients scored the severity of spontaneous pain and induced pain. The same symptoms were assessed by the investigator at 0, 48, and 96 hours. Special attention was paid to the occurrence of adverse reactions. A statistically significant difference favoring fentiazac was seen in the patients' assessments of induced pain (while eating) but not in the investigator's assessment of induced pain (percussion). There was no significant difference in the analgesic effects of fentiazac and paracetamol with respect to spontaneous pain scored by patients or the investigator. No side effects were seen. Fentiazac was shown to be an effective analgesic for use in this painful inflammatory condition.

[Postnatal maturation of the diaphragm muscle: ultrastructural and functional aspects]. / Maturation postnatale du diaphragme: des modifications ultrastructurales aux modifications fonctionnelles.

OBJECTIVE: In the diaphragm muscle, postnatal maturation is associated with major histological and biochemical modifications, as well as a progressive development of the sarcoplasmic reticulum (SR), which in turn are responsible for the progressive postnatal improvement in diaphragmatic contractility. However, the mechanisms by which postnatal maturation induces this improvement in diaphragmatic contractility remain poorly understood and controversial. The aim of this review is to analyze the data from the literature regarding the process involved in the postnatal improvement in diaphragmatic contractility. DATA SOURCES: References obtained from Pubmed((R)) databank using keywords (diaphragm muscle, postnatal maturation, contractility, muscular fatigue, cross-bridge). DATA SYNTHESIS: From a cytological point of view, the postnatal development of the diaphragm muscle is processed in two successive generations of fiber types, corresponding to the progressive adaptation of the diaphragm muscle to its physiological function. Indeed, the proportion in type I (slow, aerobic) and type IIB fibers (fast, anaerobic) progressively increases with postnatal maturation, while the proportion in type IIA fibers (fast, intermediate) progressively decreases. The histochemical classification of the type of fiber corresponds to the expression of the different isoforms of myosin heavy chains (MHC). Two types of MHC: MHC embryologic (MCH-emb) and MHC neonatal (MCH-neo), and one type of myosin light chains (MLC) are expressed in the foetal skeletal muscles, then are progressively eliminated during postnatal maturation. For many authors, this progressive transition from immature MHC (MCH-emb and neo) to adult MHC (by chronological order of appearance: MHC-2A, MHC-lente, MHC-2X, MHC-2B) could be responsible for the progressive improvement in postnatal diaphragmatic contractility. This transition could be modulated by external factors, mainly including neural and hormonal stimuli. For others, this transition in MHC expression do not play a major role, and other factors, including the postnatal maturation of the ryanodine receptor (RyR) or developmental changes in cross-bridges (CB) properties should play a central role. The most recent hypotheses proposed included the possibility of a postnatal transition in the expression of structural proteins, which are playing a major role in the maintenance of the stability of the sarcomer, and therefore in force generation.

The phenomenology of body image distortions induced by regional anaesthesia.

Patients with peripheral nerve or spinal cord lesions frequently report perceptual distortions related to position, shape, texture or temperature of the affected areas. This study aimed to describe the phenomenology of such body image alterations during the course of upper limb, lower limb or spinal anaesthetic blocks in patients (n = 36) undergoing orthopaedic surgery. Multimodal sensory testing and assessment of motor function were performed at regular intervals, and the relationship between the reported body image distortions and the progression of sensory and motor impairment was analysed. We found that perceptual changes concerning the shape and size of the deafferented limb occurred in the great majority of patients. In all of them, illusions of swelling, elongation or shortening of the limb coincided with the impairment of warm, cold and/or pinprick sensations, suggesting that thin myelinated Adelta- and/or unmyelinated C-fibres may provide a source of tonic modulation to the limb's cortical representation. Such perceptual alterations of shape and size of body parts differed clearly from postural illusions in terms of frequency, time course and influence of vision. In addition to perceptual changes in the deafferented area, almost half of the patients felt their unanaesthetized lips and/or mouth swelling during the course of upper limb block, suggesting the unmasking of dynamic interactions between somatotopically adjacent cortical representations. Conflicting sensations could co-exist in the patient's body image, such as the illusion of swelling of a limb, which, at the same time, was felt to be missing. The sense of ownership of the deafferented limb was impaired in some cases. These observations show that the perception of body shape and the awareness of its postural variations are built from different plastic models. They also underline the contribution of peripheral afferent activity to the maintenance of a unified body image.