[What academic training for pharmacy students for clinical pharmacy? Example of shared medication report]. / Quelle formation académique pour les nouvelles missions de pharmacie clinique à l'officine ? Exemple du bilan partagé de médication du sujet âgé.

OBJECTIVES: In 2018, the implementation of shared medication reports in pharmacy encourages pharmacists to cooperate with other healthcare professionals. This job allows a decrease of medication errors in elderly. This requires a reorganization of the training offered by universities (initial and continuing training). The aim is to present the results of this pedagogical experimentation. METHODS: The experimentation (years 2017-2018 and 2018-2019) required the creation of a course to allow students to carry out a pharmaceutical analysis suitable to elderly people, to set up and carry out a shared medication report in pharmacy. Then, during their 6th year internship, students had to carry out at least one shared medication report per month. A monthly follow-up was organized with a database online. RESULTS: Sixty-four students and 35 internship supervisors participated in the experimentation. All the students improved their ease in using clinical pharmacy tools (pharmaceutical analysis, pharmaceutical interventions, assessment of adherence, etc.). They carried out 345 shared medication reports. In 24.3% of cases, an improvement in the prescription was proposed to the doctor (general practitioner or specialist). For 80% of the internship supervisors, the initial training of the students helped to set up this new pharmacy activity. CONCLUSIONS: This teaching is appreciated by students and internship supervisors. It enabled the adoption of the various tools essential for carrying out shared medication reports in pharmacy. Shared medication reports reinforce the multidisciplinary work of pharmacists, especially with general practitioners.

[Regional management tool and analysis of hospital prescriptions delivered in community pharmacies: A different approach to support French health institutions]. / Outil de pilotage territorial et d'analyse des prescriptions hospitalières exécutées en ville : une nouvelle approche de l'accompagnement des établissements de santé.

Health economic regulation and relevance of care are key points for every industrialised country. To get a better medicalised control of expenditure developments, French hospitals contracts with regulation authorities (Agence Régionale de Santé) and healthcare insurance within a "contract for the improvement of the quality and efficiency of care" (CAQES). One of the monitored element is the expenses related to hospital initial prescriptions delivered in community pharmacies (PHEV). The PHEV evolution is driven by prescribing practices (in terms of relevance) But others explanatory factor are structural and more complex to identify. Among these, the characteristics of the health care institution have a strong but unmeasured impact (environment, ambulatory medical demography, etc.). To evaluate the impact of these factors and help healthcare institutions, OMéDIT BFC (Regional Healthcare Products Observatory) and ARS, developed a tool for territorial management and analysis of PHEV named OPTA-PHEV. It makes it possible to individualize their expenditure data and to identify any prescription atypicalities integrating these extrinsic parameters. This will make it possible to compare and put into perspective the different regions in order to optimize PHEV-related expenses.

[Interest of several pharmaceutical activities to secure the care pathway of elderly patients?] / Sécurisation du parcours de soins du sujet âgé : intérêt d'une offre variée d'activités pharmaceutiques ?

OBJECTIVES: In order to prevent medication errors during patient's care pathway, all transition steps must be secured. The main objective of this study was to assess the interest of medication review at hospital discharge on the sustainability of therapeutic optimizations made during hospitalisation in a geriatric population. MATERIAL AND METHODS: This was a three months prospective, single-centre study performed in an acute geriatric unit of a university hospital. All patients hospitalized during the study were included. They were divided in two groups: the securing pathway (SP) group with admission reconciliation, step 3 prescription analysis (according to the French Society of clinical pharmacy) and medication review at hospital discharge were compared to the not concerned group (NSP) with only a step 2 (according to the French Society of clinical pharmacy) prescriptions analysis. The Medication Regimen Complexity Index was used to quantify the complexity of medication regimens. RESULTS: In total, 53 patients of the SP group and 44 patients of the NSP group got the benefit of whole clinical pharmaceutical activities put in places. The average medications on discharge's drug prescription is lower in SP group (SP 8.4±3.4 medications and NSP 9.6±3.2 medications, P=0.06). The discharge's drug prescription complexity index is lower in SP group compared to NSP group (SP 27.9±9.8 and NSP 32.7±11.5, P=0.02). The same trend is observed 30 days post discharge. CONCLUSION: A medication review at hospital discharge reduces the subsequent drug prescription's complexity score. This multidisciplinary dynamic makes easier the communication between health care professionals and contributes to strengthen the city-hospital link.

Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results.

BACKGROUND: The aim of this prospective study was the evaluation of the laparoscopic treatment of common bile duct stones (CBDS) and its indications. METHODS: Five hundred five patients who underwent laparoscopic treatment of CBDS from October 1990 to September 2006 were included in the prospective study. The mean age of the patients was 63 years (range = 19-93). Four hundred fifteen patients were classified ASA I and ASA II and 90 were ASA III and ASA IV. CBDS were suspected or diagnosed preoperatively in 373 patients (73.8%) and diagnosed at intraoperative cholangiography (IOC) in 132 patients (26.2%). A transcystic duct extraction (TCDE) was attempted in 254 patients (50.4%) and a primary choledochotomy in 251 patients (49.6%). Biliary drainage after choledochotomy was used in 148 cases (48.8%). RESULTS: TCDE was successful in 191 cases (75.2%). The 63 failures were managed by laparoscopic choledochotomy in 53 cases and by endoscopic sphincterotomy (ES) in 10 cases. A choledochotomy was thus performed in 304 patients and successful in 295 cases (97%). The nine failures were managed by six conversions to laparotomy (2%) and three postoperative ES. The overall success rate was 96.2%. The morbidity rate was 7.9% with 4.8% of local complications and 3.1% of general complications. The mortality rate was 1%. There were 14 residual stones (2.8%) that were managed by a second laparoscopy in two cases and by ES in 12 cases with four failures managed by laparotomy in one case and laparoscopy in three cases. CONCLUSION: Laparoscopic management of CBDS was effective in more than 96% of cases and particularly safe in ASA I and ASA II patients. It has the advantage over ES followed by laparoscopic cholecystectomy (LS) to be a one-stage procedure.

Immunostimulating properties and three-dimensional structure of two tripeptides from human and cow caseins.

Some tripeptides obtained by enzymic digestion of caseins possess immunomodulating properties. In order to correlate activity and structure, X-ray analysis has been applied to two of them Leu-Leu-Tyr and Gly-Leu-Phe.

The influence of urea and guanidine chloride on the binding of the binding of the bacterial substrate and inhibitors to hen lysozyme at physiological temperature (40 degrees) (*).

The influence of urea and of guanidine chloride on the binding of the bacterial substrate and of inhibitors such as N-acetylglucosamine or chitotetraose to hen lysozyme were studied at 20 degrees and at 40 degrees C (physiological temperature). The action of urea did not prevent a certain degree of organization of the enzyme compatible with its usual behaviour in the presence of some inhibitors and with its crystallization ; guanidine chloride, already at low concentrations, seemed to have a more severe effect on lysozyme.

Influence of pH and ionic strength on the lysis of Micrococcus luteus cells by hen lysozyme at low (20 degree C) and high (physiological, 40 degree C) temperature.

From isoactivity curves (showing activity as a function of Ph and ionic strength) it was found that in the pH domain 6.7-8.6 frequently used in experiments involving hen lysozyme, the pH optimum of lysis of Micrococcus luteus cells at low ionic strength (0.02-0.05) by the high-temperature form (40 degree C, physiological temperature) was one to two pH units lower than that by the low-temperature form (20 degree C).

Elective laparoscopic colonic resection for diverticular disease: results of a multicenter study in 179 patients.

BACKGROUND: We undertook a retrospective multicenter study of elective laparoscopic sigmoidectomy for diverticulitis in order to assess the safety and the results of the procedure performed by a large number of surgeons. MATERIALS AND METHODS: Between January 1998 and April 1999, the French Society of Laparoscopic Surgery recruited retrospectively 179 patients from 10 surgical units, operated on for elective laparoscopic sigmoidectomy. There were 94 men and 85 women with a mean age of 58 years (range, 30-82). The indications for surgery were acute attacks in 123 cases, complicated diverticulitis in 47 cases, and miscellaneous in 9 cases. RESULTS: The performed procedure was a successful laparoscopic assisted sigmoidectomy in 154 cases (with totally intracorporeal anastomosis in 136 cases and hand-sewn anastomosis via small incision in 18 cases). The mean operation time was 223 min +/- 79 (range, 100-480). There was no mortality and 23 complications occurred in 23 patients (14.9%). Postoperative ileus lasted 2.5 +/- 0.9 days (range, 1-6), and oral intake started after 3.3 +/- 1.3 days (range, 1-12). The mean postoperative stay was 9.3 days (range, 4-50). Conversion to laparotomy was necessary in 25 cases (13.9%). The essential causes of conversion were obesity, severe adhesions, and colonic inflammation. The mean postoperative stay for the 25 converted patients was 13 +/- 8.5 days (range, 7-42). CONCLUSION: Elective laparoscopic sigmoidectomy for diverticulitis is feasible and is safe. The complication and mortality rates are similar to those observed after open procedures. For experienced surgical teams, laparoscopic colonic resection is a good approach for selected patients suffering from symptomatic diverticulitis.

One hundred laparoscopic choledochotomies with primary closure of the common bile duct.

BACKGROUND: Several technical approaches for laparoscopic CBD exploration (LCBDE) exist. Laparoscopic choledochotomy is required in some situations and whenever a transcystic approach fails. Biliary drainage after choledochotomy has a 5% morbidity rate and avoidance of biliary drains might therefore further improve the results of LCBDE. The authors report a prospective multicentric evaluation of laparoscopic choledochotomy with completion choledochoscopy and primary duct closure without any biliary drainage. METHODS: Between October 1991 and December 1997, 100 patients from four surgical centers underwent this approach for CBD stones. Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients. External ultrasound was the only preoperative imaging investigation in 87 patients. LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones (acute cholecystitis in 33% of patients, cholangitis in 10%, or mild acute pancreatitis in 6% of all patients). RESULTS: The technique was equally feasible in all participating centers (University hospital, general hospital, or private practices). Vacuity of the CBD was achieved in all patients without mortality. Eleven patients had complications and 3 patients required a laparoscopic reintervention. Median postoperative hospital stay was 6 days (range: 1-26). No patient required additional CBD procedures during follow-up. CONCLUSIONS: In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.

Laparoscopic treatment of common bile duct stones.

BACKGROUND/AIMS: Laparoscopic exploration of the common bile duct is technically possible. The aim of this prospective study was to evaluate the feasibility of the different techniques of laparoscopic treatment of common bile duct stones and their complications. MATERIALS AND METHODS: From October 1990 to December 1995, 161 patients, age from 18 to 92, underwent a laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 82 patients and was successful in 55 (67%). The failures were treated by 22 laparoscopic choledochotomies and in five patients by postoperative endoscopic sphincterotomy. A choledochotomy was performed in 101 cases and was successful in 97 (96%). The failures were treated by three laparotomies with a failure of intra-hepatic stone extraction and one postoperative endoscopic sphincterotomy. There were four residual lithiasis treated with endoscopic sphincterotomy. There were two failures treated one by laparotomy and one by laparoscopy. The total success rate was 92% (148/161). RESULTS: There was no postoperative mortality. There were five local complications, two abscesses, one liver injury, one small hemorrhage at the trocar site, and one pain lasting for more than 48 hours. There were seven general complications: two cardiac failures (medical treatment), one severe pancreatitis, one digestive hemorrhage, one psychiatric disorder, and two postoperative ileus. The total morbidity rate was 7.4% (12/161). Mean hospital stay was 7.6 days (2-36). CONCLUSIONS: Laparoscopic exploration of the common bile duct appears to be safe and effective. It could be included in the protocol of management of choledocholithiasis.

[Fatal emboligenic ulcerative endomyocardial fibrosis in filariasis]. / Fibrose endomyocardique ulcérée emboligène mortelle chez un filarien

A man of 54 had been treated over a 15 month period for pulmonary tuberculosis when aged 41, and had lived on the Ivory Coast and then in the Cameroons for 20 years. Eye signs were discovered in January 1971, and these, together with an eosinophilia, pointed to a possible filariasis which was later confirmed by immunofluorescence and the fixation of complement. Three months later, the patient developed congestive cardiac failure. On the 4th day of treatment with Notizine, multiple systemic emboli occurred, leading to death. Autopsy showed endomyocardial fibrosis with multiple ulceration of the left ventricle, the site of the emboli. The aetiology from filariasis and the mechanism of ulceration of the parietal endocarditis are discussed.

[Treatment of common bile duct stones with laparoscopy. Retrospective multicenter study with 612 patients]. / Traitement de la lithiase de la voie biliaire principale sous laparoscopie. Etude rétrospective multicentrique chez 612 malades.

OBJECTIVE: To analyse retrospectively the results of one-stage laparoscopic treatment for common bile duct stones in 19 surgical centers in France. PATIENTS: From January 1991 to July 1996, 612 patients with choledocholithiasis underwent laparoscopic treatment. RESULTS: Overall duct clearance was obtained in 489 of the 612 patients (80%): through the cystic duct in 222 of 380 patients (58.4%), by secondary choledochotomy (after unsuccessful transcystic duct extraction) in 77 of 96 (80%), and in 190 of 232 (82 %) by primary choledochotomy. The overall duct clearance rate increased from 65% in 1991 to 84% in 1996. The use of the choledochotomy approach increased from 43% in 1991 to 69% in 1996 (P<0.01), due to a substantial increase in primary choledochotomy. In contrast, the use of the transcystic approach decreased from 57% to 31% (P<0.01). The mean time for surgery was shorter for cystic duct exploration than for primary choledochotomy (101+/-51 vs. 155+/-62 min, P<0.0001). The mean hospital stay decreased from 7.7+/-3.6 days in 1991 to 4.1+/-2 days in 1996 (P<0.001). The main biliary complications were related to biliary drainage (2,8%) and retained stones (3.1%). CONCLUSION: This study confirms that laparoscopy is a good alternative with a low complication rate, a short hospital stay, and is an effective and safe option for the management of common bile duct stones.

[Degradation of copper IUDs in utero. The process of metallic corrosion. A scanning electron microscope study]. / Dégradation in utero des DIU au cuivre en fonction du temps. Le phénomène de corrosion métallique. Etude au microscope électronique à balayage.

OBJECTIVE: The present investigation was carried out in order to study the process of metallic corrosion of copper IUD's in utero, to precise its dynamics and location along the IUD and to appraise the influence of eventual calcareous deposition. MATERIAL AND METHODS: A total of 461 copper IUDs representing four standard models were screened by means of optical microscopy. Especially typical samples were studied at higher magnifications under the scanning electron microscope. The obtained data were considered in terms of statistics. RESULTS: It was possible to demonstrate a preferential corrosive activity in the lower part of the IUD without significant variations between the models. It was also possible to precise the steps of the process, to describe its most characteristic aspects and to study the eventual effect of severe calcareous deposition on corroded copper. DISCUSSION AND CONCLUSIONS: Intrauterine copper corrosion is a normal process which occurs preferentially in the cervical portion of an IUD and can lead to the total metal loss. Both its initiation and evolution are submitted to strong individual variations. Thick and compact vaterite deposits may thwart copper erosion in case of drastic and rapid deposition.

[I.U.D. degradation in utero as a function of time: the phenomena of calcification. Radiocrystallographic and scanning electron microscopy study]. / Dégradation des D.I.U. in utero en fonction du temps: le phénomène de calcification. Etude radiocristallographique et au microscope électronique à balayage.

OBJECTIVE: A study was undertaken in order to determine the frequency of the process of calcareous deposition, to clarify the nature of the deposits, their arrangement along the IUD and their possible influence on the appearance of metrorrhagias. MATERIAL AND METHODS: A total of 408 coopper IUD's belonging to four standard models were observed by means of optical microscopy at low magnifications. The most typical samples were studied under the scanning electron microscope and deposits analyzed by crystallography. The data were analysed statistically. RESULTS: It was possible to determine both the frequency and the importance of the process of calcification according to the model of IUD and to the bearing time, to demonstrate a preferential location of concretions and to suspect a sensibility to the phenomenon variable according to the model. It was also possible to clarify the stages of the process of calcification, to describe its most characteristic aspects and to identify the essential component of calcareous deposits. CONCLUSIONS: Calcification concerns roughly over 50% of IUD's in utero. It occurs preferentially on the fundic portion of an IUD. Obviously, the minimal time required for the phenomenon to start as well as to increase its intensity are submitted to strong individual variations. Concretions are composed of vaterite, a distinct variety of carbonate of calcium. They do not seem to be the primary cause of possible metrorrhagias.

[Role of laparoscopy in the current treatment of lithiasis of the common bile duct. Apropos of 63 cases of lithiasis]. / Place de la laparoscopie dans le traitement actuel de la lithiase de la voie biliaire principale. A propos de soixante-trois cas de lithiase.

The purpose of this study is to evaluate the operative technique, indications and results of laparoscopic management of common bile duct (CBP) stones. While laparoscopic cholecystectomy has become the procedure of choice for gallstones, the management of CBD stones remains controversial. From October 1989 to may 1993, we performed 634 cholecystectomies, 615 of them carried out by laparoscopy, (97%). We found 63 cases of CBD stones (9.9%). At the beginning, CBD stones were managed either by endoscopic sphincterotomy (12 cas) or by laparotomy (6 cas). We subsequently performed laparoscopic treatment of CBD stones. Forty-six patients have been treated in this way: 17 via a transcystic approach successfully in 14 cases (82.3%) and 29 by choledochotomy with 27 successful extractions (93.1%). There was no mortality and a morbidity of 4.3% (1 retained stone and 1 wound infection). Endoscopic sphincterotomy is indicated in high risk elderly patients and in complicated stones. (pancreatitis cholangitis), while the whereas incidence of open surgery is greatly reduced; the advantages of laparoscopic management of CD stones are its noninvasive aspect and the complete clearance of the stones in one operation.

[Laparoscopic treatment of common bile duct calculi]. / Traitement laparoscopique de la lithiase de la voie biliaire principale.

Laparoscopic exploration of the common bile duct is now technically possible. This prospective study evaluates the feasibility of the different techniques and their complications. From January 1990 to March 1995, 140 patients, aged from 22 to 92, underwent laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 70 patients and was successful in 46 (65.7%). The failures were treated by 19 laparoscopic choledochotomies and 5 postoperative endoscopic sphincterotomies. A choledochotomy was performed in 89 cases and was successful in 85 (94.4%). The failures were treated by 3 laparotomies and 2 postoperative endoscopic sphincterotomy. The total success rate was 92.8% (130/140). The 5 local complications were pain (1), liver injury (1), and wound abscess (2), bleeding from a trocar site. Heart failure (medical treatment) (2), gastrointestinal haemorrhage from intestinal angiomas, severe pancreatitis after transcystic failure and psychiatric disorders were the 5 general complications. The total morbidity rate was 7.1%. There were 2 residual common bile duct stones. The mortality rate was 0. Mean hospital stay was 7.8 days. Laparoscopic exploration of the common bile duct appears to be safe and effective and should be included in the management protocol of choledocholithiasis.

[Alveolar cancer and localized parieto-alveolar fibrosis]. / Cancer alvéolaire et fibrose pariéto-alvéolaire localisée.

We report a case, cytologically diagnosed, of broncho-alveolar cancer associated with localised interstitial pulmonary fibrosis. This association of fibrosis with bronchiolo-alveolar cancer is classical and a pathogenic affiliation has been deduced by the majority of authors. We review the pathogenesis in relation to recent datas concerning the activation of successive oncogenes: the first stage of carcinogenesis may correspond to the activation of an oncogene coding for a fibroblastic growth factor leading to fibrosis.