[Video: An innovation for developmental care in the neonatal intensive care unit]. / La surveillance vidéo : une innovation au service des soins de développement en unité de soins intensifs de néonatologie.

INTRODUCTION: Our neonatal intensive care unit (NICU) was designed with a web-camera system in eight private rooms and four open wards. This equipment was installed to both guarantee children's safety in the NICU and promote the bond between the child and his/her family through a viewing service permitted by an Internet access. METHOD: We evaluated the web-camera system in its 5th year with two types of users. The nursing staff was asked about use of the video and its impact on their management of NICU patients. Questionnaires for parents sought to determine how they used the system and their feelings about it. RESULTS: Ninety-three percent of the nursing staff used the web-camera system to provide medical supervision or to comply with developmental care, mainly to respect the baby's natural rhythm by initiating care only when the baby showed signs of awakening. The web-camera system allowed them to observe the baby, verify his/her good body position, and spot discomfort situations. It helped provide a faster and personalized answer that was adjusted to the baby's needs. Sixty-one percent of the parents used the remote connection, half of them to present the child to the family. Only 17% of parents were embarrassed by the cameras; 88% of parents thought that the video was an additional safety device in NICU management. CONCLUSION: The web-camera system appeared to be an interesting technology in the NICU to support developmental care when children could be put in private rooms. It helped staff react faster to situations that created an inappropriate stimulation for the baby. It also allowed to them to respect the baby's natural rhythm. It reassured nursing staff and parents and it facilitated the baby's integration into the family.

Significant risk factors for occurrence of cancer after renal transplantation: a single center cohort study of 1265 cases.

Occurrence of cancer after renal transplantation remains a major problem, and the second cause of death. We performed a retrospective analysis of first cancer, first skin cancer, and first organ cancer (including posttransplant lymphoproliferative disease [PTLD]) among 1265 cases from 1979 to 2006. The occurrence of cancer was clearly a time-dependent event justifiying the use of Kaplan-Meier survival and Cox regression methods. The 10-year cumulative incidences of first cancer, first skin cancer, and first organ cancer were 24.6%, 14.5%, and 14.5%, respectively. Recipient age was a major, independent risk factor for the 3 endpoints with a 6% increased relative risk for each year increment (P < .0001). Female gender was also a major, independent risk factor, but only for skin cancer (P = .0002). We could not demonstrate any difference between the immunosuppressive drugs used for induction or maintenance therapy, especially between antithymocyte globulin (ATG) vs anti-CD25, cyclosporine vs tacrolimus, and azathioprine vs mycophenolate mofetil. Large cohorts are needed with strict stratifications for recipient age and gender to detect any difference, if any, among the drugs.

[Outcomes and quality of life of elderly patients older than 80 years three months after a stay in an intensive care unit]. / Devenir et qualité de vie d'une population âgée de plus de 80 ans trois mois après un séjour en réanimation.

OBJECTIVES: The aging of the population has seen an increase in the number of elderly patients admitted to reanimation units. We sought to know the outcomes and evolution of the quality of life of a population of elderly patients after their experience with this type of service. METHOD: We included all patients older than 80 years who had been in two intensive care units in the Loire region of France between October 2005 and May 2006. We studied their state of mind 3 months after they exited the service. Then, for the survivors, we used the Activities of Daily Living (ADL) scale and the generic questionnaire of health, the SF-36, to evaluate the evolution of their degree of autonomy and quality of life related to health compared to that one month prior to entry in the reanimation unit. RESULTS: We included 70 patients (mean age 85.2+/-4.5 years). At 3 months after exiting reanimation, the survival rate was 57%, and 28 survivors underwent rating scale testing. The physical score of the SF-36 and the ADL score were significantly decreased as compared with that one-month before admission, with no significant difference in mental score of the SF-36. Physical deterioration did not have a significant effect on the evolution of perceived health (dimension GH of the SF-36), life and relations with others (dimension SF) or mental health (dimension MH). The decreased ADL score was correlated with that of the two physical dimensions of the SF-36, with no correlation with the four psychic dimensions. A total of 92% of patients were satisfied with their care in reanimation and three of four would agree to go back if their state required it. For the others, it is a question of respecting the will of the elderly patients confronted with reanimation care. CONCLUSION: Three months after intensive care with reanimation, elderly patients do not have significantly modified perceived health and psychic state as compared with objective deteriorated physical capacity. The absence of consensus on the threshold of old age and the quality-of-life instrument to use prevents a comparison of our results with those in the literature. However, others have shown and we agree that elderly people could benefit from reanimation therapy.

[Is cocoa a psychotropic drug? Psychopathologic study of a population of subjects self-identified as chocolate addicts]. / Le cacao est-il un psychotrope? Etude psychopathologique d'une population de sujets s'identifiant comme chocolatomanes.

The aim of this work was to search for eating disorders, DSM III-R Axis I mental disorders, personality disorders, and addictive behavior, in self-labeled "chocolate addicts". Subjects were recruited through advertisements placed in a university and a hospital. Fifteen subjects were included, 3 men and 12 women aged between 18 and 49. Most of them were not overweight, although 7 thought they had a weight problem. They consumed an average of 50 g per day of pure cacao and, for 13 subjects, this consumption was lasting since childhood or adolescence. The psychological effects of chocolate, as indicated by the subjects, consisted in feelings of increased energy or increased concentration ability, and in an anxiolytic effect during stress. Seven subjects described minor withdrawal symptoms. None of the subjects reached the thresholds for eating disorders on the EAT and BULIT scales. The structured interview (MINI) identified an important ratio of subjects with a history of major depressive episode (13/15), and one woman was currently experiencing a major depressive episode. Four people suffered, or had suffered from anxiety disorders. Although only one subject satisfied all criteria for a personality disorder on the DIP-Q, seven displayed some pathological personality features. The self-labeled "chocoholics" do not seem to suffer from eating disorders, but may represent a population of psychologically vulnerable and depression--or anxiety--prone people. They seem to use chocolate as a light psychotropic drug able to relieve some of their distress. The amount of cacao consumed, although very chronically, remains moderate, and they rarely display other addictive behaviors.

[Clinical or biological symptoms leading to the search for amyloidosis]. / Symptômes cliniques ou biologiques devant amener à rechercher une amylose.

INTRODUCTION: The extracellular, multifocal, disseminated or diffuse localization of amyloidosis accounts for the diversity of clinical presentations and late diagnosis. CURRENT KNOWLEDGE AND KEY POINTS: However, early diagnosis is important, as new drugs have been recently introduced. Both clinical picture and biology help guide diagnosis, including either kidney, heart, skin or neurologic involvement associated with monoclonal gammapathy (primary idiopathic amyloidosis AL); underlying inflammatory or infectious disease, familial Mediterranean fever with proteinuria (secondary amyloidosis AA); cardiac, neurologic or ocular involvement (heredofamilial amyloidosis); carpal tunnel syndrome, joint pain (amyloidosis of hemodialysis). Furthermore, amyloid fibrils are identified on salivary gland biopsy. FUTURE PROSPECTS AND PROJECTS: Due to the introduction of new specific drugs aimed at curing various amyloidoses, early diagnosis is important. Chemotherapy and hematopoietic stem cell transplantation are promising regarding AL amyloidosis, while liver transplantation has proven remarkably successful in heredofamilial amyloidosis. Progress in molecular biology should allow identification of various forms of familial amyloidosis.

Growth factors and proinflammatory cytokines in the renal involvement of POEMS syndrome.

The POEMS syndrome is a multisystemic syndrome associated with plasma cell dyscrasia, characterized by the combination of polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. Renal involvement in POEMS syndrome is rare (26 reported cases). It has been described as membranoproliferative glomerulonephritis-like lesions (MPGN-like), mesangiolytic glomerulonephritis, or thrombotic microangiopathy. Proinflammatory cytokines (TNF-alpha, IL-1, IL-6) have been implicated in the physiopathogenesis of POEMS syndrome, particularly when there is renal involvement. Growth factors (FGF-beta, TGF-beta, PDGF) have been implicated in renal lesions of the same histological type but of different origins. An increase in serum vascular endothelial growth factor (VEGF) has been reported in POEMS syndrome (20 of 22 cases). Circulating levels of these factors were determined in 4 patients with POEMS and renal involvement (3 MPGN-like, 1 MPGN-like, and mesangiolysis) and compared with those obtained in 4 patients with POEMS without clinical renal involvement and in 4 patients with primitive membranoproliferative glomerulonephritis (MPGN). TNF-alpha, IL-1beta, and IL-6 were determined with an immunoradiometric assay, and VEGF, PDGF, FGF-beta, and TGF-beta with an enzyme-linked immunosorbent assay. Among the patients with POEMS syndrome, there was no difference in proinflammatory cytokines and growth factors between those with or without renal involvement. VEGF is the only growth factor that differentiates MPGN in POEMS syndrome from primitive MPGN.