[How I treat ... out-of-hospital cardiac arrest. The role of the emergency medical dispatcher]. / Comment je traite ... l'arrêt cardio-respiratoire extrahospitalier: la fenêtre du centraliste 112.

Sudden cardiac arrest is an event associated with a very low survival rate. The latter is inversely proportional to the duration of the cardiovascular arrest. The chain of survival concept is a sequence of 4 events to be carried out as fast as possible with a view to ensure the patient's survival. This sequence consists of early access to and activation of the emergency medical system, early initiation of basic cardiopulmonary resuscitation, early defibrillation and early specialized care. The number of potential witnesses trained in Basic Life Support (BLS) does not guarantee an adequate basic resuscitation before the arrival of medical aid. In order to optimize the management of victims and callers, the concept of dispatching-assisted cardiopulmonary resuscitation based on a structured protocol has been implemented. The implementation of this plan to improve the quality of call handling required training and assessment of impacts on beneficiaries. The research datashow a reduction of the duration of cardiac arrest, an increase in resuscitation initiated by a witness, an improved survival rate, and a decreased stress and unanimous approval of dispatchers. Currently, the process is being improved and sustained.

Analysis of the volatile organic matter of engine piston deposits by direct sample introduction thermal desorption gas chromatography/mass spectrometry.

This article establishes an alternative method for the characterization of volatiles organic matter (VOM) contained in deposits of the piston first ring grooves of diesel engines using a ChromatoProbe direct sample introduction (DSI) device coupled to gas chromatography/mass spectrometry (GC/MS) analysis. The addition of an organic solvent during thermal desorption leads to an efficient extraction and a good chromatographic separation of extracted products. The method was optimized investigating the effects of several solvents, the volume added to the solid sample, and temperature programming of the ChromatoProbe DSI device. The best results for thermal desorption were found using toluene as an extraction solvent and heating the programmable temperature injector from room temperature to 300 degrees C with a temperature step of 105 degrees C. With the use of the optimized thermal desorption conditions, several components have been positively identified in the volatile fraction of the deposits: aromatics, antioxidants, and antioxidant degradation products. Moreover, this work highlighted the presence of diesel fuel in the VOM of the piston deposits and gave new facts on the absence of the role of diesel fuel in the deposit formation process. Most importantly, it opens the possibility of quickly performing the analysis of deposits with small amounts of samples while having a good separation of the volatiles.

[Appearance of Escherichia coli strain with high production of cephalosporinase during treatment with an amoxicillin and clavulanic acid combination]. / Emergence d'une souche d'Escherichia coli hyperproductrice de céphalosporinase au cours d'un traitement par l'association amoxicilline plus acide clavulanique.

In the course of an Escherichia coli cholecystitis, demonstrated by positive blood cultures, the authors observed a therapeutic failure with amoxicillin/clavulanate, probably related to the isolation in blood cultures, nine days after the beginning of the treatment, of a beta-lactam resistant E. coli strain (MICs of the amoxicillin combined with clavulanate was 64 mg/l and ceftazidim 16 mg/l). The strains which were recovered before and after treatment were shown to have the same biotype and the same electrophoretic profile for bacterial esterases. The second strain exhibited a high level production of the mediated chromosomal cephalosporinase. In the agar diffusion test, this mutant was more easily detected by ceftazidim than by other third generation cephalosporins. In the middle-stay unit where the patient was cured, cephalosporinase high producing mutants of E. coli were recovered in 0.6 p. cent of the strains versus 5, 1 p. cent for strains with cephalosporinase phenotype and 46.6 p. cent for strains with penicillinase phenotype. This report illustrates the importance of associating two synergistic antibiotics to prevent the emergence of beta-lactam resistant mutants in the course of severe E. coli infections.

[Endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. Two case reports]. / Traitement endoscopique du reflux vésico-urétéral par injection sous-méatique de graisse autologue. A propos de deux cas.

The authors report two cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. We describe the technique of prelevement and injection. The immediate results confirm the efficacity of this procedure. The long-term follow-up will allow us to adopt it and to give it some modifications.

[Youssef syndrome (vesico-uterine fistula): three case reports]. / Le syndrome de Youssef (fistule vésico-utérine): à propos de trois observations.

The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.

[Retroperitoneal liposarcoma. Case report]. / Liposarcome rétropéritonéal. A propos d'un cas.

We report one case of retroperitoneal liposarcoma treated by surgery and radiotherapy. With the literature, we discuss the pathologic and therapeutic aspect of this lesion.

[Treatment of stafhorn calculi. Report of 71 cases]. / Traitement des lithiases coralliformes complexes. A propos de 71 cas.

OBJECTIVE: We retrospectively investigated 63 patients suffering from 71 staghorn calculi, who were treated with primary surgical monotherapy, in order to determine long-term. results and the fate of the residual stones. MATERIAL AND METHODS: Mean follow-up was 2.6 years. There were 63 patients (32 men, 31 women). The treatment was pyelolithotomy alone in 26 cases; nephrolithotomy alone in 14 cases; pyelolithotomy associated with nephrolithotomy in 18 cases; percutaneous nephrolithotomy (PCNL) in two cases; extracorporeal shock-wave lithotripsy (ESWL) in one case; and nephrectomy in ten cases. RESULTS: At the conclusion of therapy the stone-free rate was 94.1%. The complication was septic complications in 12 patients, hemorrhage that needed transfusion in five case and fistula in one case. After four and six years, two patients developed renal insufficiency and two patients had a recurrence of stones. CONCLUSION: Primary surgery of complex staghorn calculi is justified because of its better results than PCNL associated with ESMIL.

[Complex tubercular ureteral stenoses (report of 2 cases treated with permanent double-J catheter]. / Sténoses urétérales complexes tuberculeuses (à propos de deux cas traités par sonde double J définitive).

Two patients presenting complex tuberculous ureteral strictures on an only existing kidney were treated with definitive double J stent changed every 6 months. This treatment modality was well tolerated. On the basis of two cases and literature review, different therapeutic measures are discussed.

Primary malignant melanoma of prostate.

Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate.