RESUMEN
The prognosis of oncology patients admitted to the intensive care unit (ICU) is considered poor. Our objective was to analyze the characteristics and predictive factors of death in the ICU and functional outcome following ICU treatment for neuro-oncology patients. A retrospective study was conducted on all patients with primary brain tumor admitted to our institutional ICU for medical indications. Predictive impact on the risk of death in the ICU was analyzed as well as the functional status was evaluated prior and following ICU discharge. Seventy-one patients were admitted to the ICU. ICU admission indications were refractory seizures (41 %) and septic shock (17 %). On admission, 16 % had multi-organ failure. Ventilation was necessary for 41 % and catecholamines for 13 %. Twenty-two percent of patients died in the ICU. By multivariate analysis, predictive factors associated with an increased risk of ICU death were: non-neurological cause of admission [p = 0.045; odds ratio (OR) 5.405], multiple organ failure (p = 0.021; OR 8.027), respiratory failure (p = 0.006; OR 9.615), and hemodynamic failure (p = 0.008; OR 10.111). In contrast, tumor type (p = 0.678) and disease control status (p = 0.380) were not associated with an increased risk of ICU death. Among the 35 evaluable patients, 77 % presented with a stable or improved Karnofsky performance status following ICU hospitalization compared with the ongoing status before discharge. In patients with primary brain tumor admitted to the ICU, predictive factors of death appear to be similar to those described in non-oncology patients. ICU hospitalization is generally not associated with a subsequent decrease in the functional status.
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Neoplasias Encefálicas/mortalidad , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Adulto JovenRESUMEN
INTRODUCTION: An amphibious assault ship was deployed on 22 March in Corsica to carry out medical evacuation of 12 critical patients infected with COVID-19. The ship has on-board hospital capacity and is the first time that an amphibious assault ship is engaged in this particular condition. The aim is to evaluate the feasibility and safety of prolonged medical evacuation of critical patients with COVID-19. METHODS: We included 12 patients with confirmed COVID-19 infection: six ventilated patients with acute respiratory distress syndrome and six non-ventilated patients with hypoxaemia. Transfer on an amphibious assault ship lasted 20 hours. We collected patients' medical records: age, comorbidities, COVID-19 history and diagnosis, ventilation supply and ventilator settings, and blood gas results. We calculated oxygen consumption (OC). RESULTS: All patients had a medical history. The median delay from onset of symptoms to hospitalisation was 8 (7-10) days. The median Sequential Organ Failure Assessment score on admission was 3 (2-5). There was no significant increase in oxygen during ship transport and no major respiratory complication. There was no significant increase in arterial oxygen pressure to fractional inspired oxygen ratio among ventilated patients during ship transport. Among ventilated patients, the median calculated OC was 255 L (222-281) by hours and 5270 L (4908-5616) during all ship transport. Among non-ventilated patients, the median calculated OC was 120 L (120-480) by hours and 2400 L (2400-9600) during all ship transport. CONCLUSION: The present work contributes to assessing the feasibility and safety condition of critical COVID-19 evacuation on an amphibious assault ship during an extended transport. The ship needs to prepare a plan and a specialised intensive team and conduct patient screening for prolonged interhospital transfers.
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COVID-19/complicaciones , Medicina Militar , Personal Militar , Transferencia de Pacientes , Navíos , Anciano , COVID-19/terapia , Estudios de Factibilidad , Femenino , Francia , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Respiración Artificial , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/virología , Estudios Retrospectivos , Tiempo de TratamientoRESUMEN
General anesthesia (GA) is a reversible manipulation of consciousness whose mechanism is mysterious at the level of neural networks leaving space for several competing hypotheses. We recorded electrocorticography (ECoG) signals in patients who underwent intracranial monitoring during awake surgery for the treatment of cerebral tumors in functional areas of the brain. Therefore, we recorded the transition from unconsciousness to consciousness directly on the brain surface. Using frequency resolved interferometry; we studied the intermediate ECoG frequencies (4-40 Hz). In the theoretical study, we used a computational Jansen and Rit neuron model to simulate recovery of consciousness (ROC). During ROC, we found that f increased by a factor equal to 1.62 ± 0.09, and δf varied by the same factor (1.61 ± 0.09) suggesting the existence of a scaling factor. We accelerated the time course of an unconscious EEG trace by an approximate factor 1.6 and we showed that the resulting EEG trace match the conscious state. Using the theoretical model, we successfully reproduced this behavior. We show that the recovery of consciousness corresponds to a transition in the frequency (f, δf) space, which is exactly reproduced by a simple time rescaling. These findings may perhaps be applied to other altered consciousness states.
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Anestésicos Intravenosos/farmacología , Encéfalo/efectos de los fármacos , Estado de Conciencia/efectos de los fármacos , Propofol/farmacología , Inconsciencia/tratamiento farmacológico , Encéfalo/fisiología , Electroencefalografía/métodos , Femenino , Humanos , Masculino , Factores de Tiempo , Vigilia/efectos de los fármacosRESUMEN
Among trauma patients, blunt chest trauma remains a major cause of morbidity and mortality. We report the case of an 85-year old patient under new oral anticoagulant implicated in a multiple-vehicle accident. The patient presented a complex thoracic trauma involving multiple rib fractures, flail chest, hemothorax and lung contusions. All the thoracic lesions were situated at the left side. Despite the absence of neurological lesion and hemodynamic instability, the patient required the admission in our intensive care unit related to the worsening of a respiratory distress. This respiratory distress resulted from the association of the thoracic injuries with related hypoxemia and a high level of pain. The management of this case included the reversal of the anticoagulant therapy, use of non-invasive ventilation, the placement of a paravertebral block and the surgical fixation of the flail chest. We provide a discussion of the risk/benefit balance for all the medical and surgical strategies used in this case as the interest of chest ultrasonography in thoracic trauma situations.
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Traumatismos Torácicos/terapia , Anciano de 80 o más Años , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/terapia , Tórax Paradójico/terapia , Humanos , Masculino , Ventilación no Invasiva , Derrame Pleural/terapia , Traumatismos Torácicos/sangre , Traumatismos Torácicos/cirugíaAsunto(s)
Catarata/congénito , Adolescente , Adulto , Catarata/genética , Niño , Preescolar , Consanguinidad , Femenino , Genes Dominantes , Humanos , Lactante , MasculinoAsunto(s)
Glaucoma/congénito , Adolescente , Adulto , Niño , Preescolar , Consanguinidad , Femenino , Genes Recesivos , Asesoramiento Genético , Glaucoma/genética , Glaucoma/prevención & control , Humanos , Lactante , Recién Nacido , Masculino , LinajeAsunto(s)
Enfermedades Linfáticas/diagnóstico , Adolescente , Adulto , Anciano , Biopsia , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Ganglios Linfáticos/patología , Enfermedades Linfáticas/etiología , Masculino , Persona de Mediana Edad , Cuello , Estudios Retrospectivos , Tuberculosis Ganglionar/diagnósticoAsunto(s)
Transformación Celular Neoplásica/patología , Leucemia Linfoide/patología , Leucemia Mieloide/patología , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Humanos , Leucemia Linfoide/diagnóstico , Leucemia Linfoide/tratamiento farmacológico , Masculino , Prednisona/administración & dosificación , Vincristina/administración & dosificaciónRESUMEN
A p phenotype was discovered in a Tunisian woman and in three of her seven children. This paradoxical result challenges the known hypotheses on this phenotype, which generally recognise that it is determined by the existence of a very rare allele in a double dose. The computation of the coefficient of inbreeding of these subjects showed that repeated intermarriages increased the coefficient of kinship of the propositus and her husband to 0.116 (if unknown women of the ancestry were assumed to be different for each child) through 0,1362 (if unknown women of the ancestry were assumed to be the same for sibs). Therefore inbreeding was proved to be so high as to induce the presence of a recessively defined phenotype in two successive generations. Moreover, the search for probability of origin of genes of the last generation showed that the BCH ancestor was probably the carrier of the p allele.
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Antígenos de Grupos Sanguíneos/genética , Consanguinidad , Sistema del Grupo Sanguíneo P/genética , Alelos , Femenino , Genes , Humanos , Masculino , Linaje , Fenotipo , TúnezRESUMEN
The intensity and the phase of ultrashort pulses from a self-mode-locked Ti:sapphire laser operating in the vicinity of zero group-delay dispersion (GDD) have been completely characterized by the technique of frequency-resolved optical gating (FROG). For small values of negative GDD, the appearance of a dispersive wave in the pulse spectrum is manifested in the measured FROG trace, and pulse retrieval directly shows its association with a broad leading-edge pedestal. For positive GDD, we confirm previous experimental observations of picosecond pulses with large positive chirp and report a new operating regime in which the output pulses are of picosecond duration but are intensity modulated at 20 THz. The physical origin of this modulation is discussed by analogy with similar effects observed during pulse propagation in optical fibers, and the experimental results are compared with a model of intracavity four-wave mixing about the cavity zero GDD wavelength.
RESUMEN
The genetic analysis of 101 genealogical trees of families with spinocerebellar heredo-degeneration enabled the authors to specify the transmission inheritance for each clinical type. Autosomic recessive transmission has been observed for Friedreich's ataxia (68 out of 69 families), Pierre-Marie's heredo-ataxia (15 families) and familial spastic paraplegia (2 families). A dominant mode of transmission has been observed in 13 families affected by familial spastic paraplegia (Strumpell-Lorrain) and in only one family with Friedreich's ataxia (an intermediate or incomplete form). It has also been observed that the consanguinity rate among this group of families is very high compared with that of the general tunisian population (25%). Marriage between cousins occurs in 75% of the cases of Friedreich's ataxia, in 78% of the cases of Pierre-Marie's heredo-ataxia and in only 61% of familial spastic paraplegia of Strumpell-Lorrain. The authors have come to the conclusion that the recessive autosomic transmission of the spino-cerebellar heredo-degenerative diseases are closely related to a high consanguinity rate.