A multicentre survey investigating the knowledge, behaviour, and attitudes of surgical healthcare professionals to frailty assessment in emergency surgery: DEFINE(surgery).

PURPOSE: Screening for frailty in people admitted with emergency surgical pathology can initiate timely referrals to enhanced perioperative services such as intensive care and geriatric medicine. However, there has been little research exploring surgical healthcare professionals' opinions to frailty assessment, or accuracy in identification. This study aimed to assess the knowledge, behaviour, and attitudes of healthcare professionals to frailty assessment in emergency surgical admissions. METHODS: We designed a cross-sectional multicentre study developed by a multiprofessional team of surgeons, geriatricians, and supported by patients. A semi-structured survey examined attitudes and behaviours. Knowledge was assessed by comparing respondents' accuracy in scoring twenty-two surgical case vignettes using the Clinical Frailty Scale. RESULTS: Eleven hospitals across England, Wales, and Scotland participated. Two hundred and eleven clinicians responded-20.4% junior doctors, 43.6% middle grade doctors, 24.2% senior doctors, 11.4% nurses and physician associates. Respondents strongly supported perioperative frailty assessment. Most were already assessing for frailty, although frequently not using a standardised tool. There was a strong call for more frailty education. Participants scored 2175 vignettes with 55.4% accurately meeting the gold standard; accuracy improved to 87.3% when categorised into "not frail/mildly frail/severely frail" and 94% when dichotomised to "not frail/frail". CONCLUSION: Frailty assessment is well supported by healthcare professionals working in surgery. However, standardised tools are not routinely being used, and only half of respondents could accurately identify frailty. Better education around frailty assessment is needed for healthcare professionals working in surgery to improve perioperative pathway for people living with frailty.

[Generalized eruptive keratoacanthomas of Grzybowski: A case report followed over 11 years]. / Kératoacanthomes généralisés multiples de Grzybowski : suivi d'un cas clinique sur 11 ans.

Since 1950, the year of Grzybowski's syndrome description by Marian Grzybowski in Warsaw, 30 cases have been described in the literature. This syndrome belongs to the family of multiple generalized keratoacanthomas (KA). It occurs in adults between 50 and 70 years. Clinically, it presents as a rash of hundreds or thousands of small papules 1 to 2mm with well-defined, sometimes keratotic center. The onset is sudden, the evolution is progressive and chronic. It is accompanied by severe and persistent pruritus. There is no family history of KA and histology is compatible with that of KA. Other criteria may be present to varying degrees: the type of facial rash Mask of Zorro, mucosal rash, ectropion, the presence of crater-like lesions. We studied the case of a 58-year-old patient followed in the plastic surgery department of Nîmes' hospital for excision of several skin tumors as part of a Grzybowski's syndrome evolving since 2005. Its handling global and multidisciplinary treatments combining early surgical and complex medical treatments represents a therapeutic challenge.

Mode of action of a fatty acid-based natural product to control Botrytis cinerea in grapes.

AIMS: To investigate the efficacy and mode of action of the fatty acid-based product Foodcoat(®) (FC) against Botrytis cinerea. METHODS AND RESULTS: In vitro, in vivo and field experiments were carried out to investigate the effect of different concentrations of FC on B. cinerea germination and infection of grape leaves and berries, using three selected isolates and comparing results with those achieved by the commercialized product Protector(HML) (PRT). Furthermore, the effect of field applications of FC on the grape berry microbiota was investigated. FC reduced B. cinerea germination and grape berry severity by up to 54 and 96%, respectively, compared with the untreated controls. CONCLUSIONS: Foodcoat demonstrated efficacy that was equal or greater than the registered product, PRT. A multiple mode of action was hypothesized for FC suppression of B. cinerea, including: inhibition of germination and germ tube alteration, protection of host green tissues and enhancement of the natural yeast populations on the berry surface. SIGNIFICANCE AND IMPACT OF THE STUDY: The efficacy of both products has been quantified and their modes of action described, suggesting them for field applications against B. cinerea, alone or in combined strategies. This is also the first report of a fatty acid-based product stimulating natural yeast populations on grape berries.

[Rose necrosis: Necrotizing granulomatous reaction with infected node at red pigment of a tattoo]. / La nécrose de la rose : réaction granulomateuse et nécrotique avec adénite au pigment rouge d'un tatouage.

INTRODUCTION: Nowadays, necrotizing cutaneous reaction after a tattoo is rare especially with the sterile tattoo equipment and antisepsis rules. We report the rare case of a necrotizing reaction secondary to a granulomatous reaction after a red tattoo, with a satellite node. CASE REPORT: A 40-year-old patient suffering from a granulomatous reaction to red dye of a large pectoral tattoo, with cutaneous and sub-cutaneous necrosis, and an infected axillary node. This pectoral tattoo also triggered a necrotizing granulomatous reaction on red-pigmented areas of other older tattoos. Local treatments (dressings, antibiotics, repeated excisions of necrotizing tissues) did not stop the allergic reaction, and an infectious origin was eliminated. The patient asked for a complete excision of the pectoral tattoo. Black intramacrophagic pigment was found in the black lymph node analysed. We did not experience any complications and the patient is satisfied with the results. DISCUSSION: Very few examples of cutaneous necrotizing secondary to a tattoo have been found in the literature. The hypothesis of a primitive infection that had secondarily led to necrosis is refuted by the lack of infective structures found in the analysed node, and most of all by the same reaction on other older tattoos on red-pigmented areas. This rare complication must be known by plastic surgeons, who will probably be called upon to take care of more and more tattooed patients. CONCLUSION: Even if it's rare, necrosis with a granulomatous reaction to red pigment after a tattoo must be known. This case illustrates a very violent immune reaction where infection was not proved.

[Post-traumatic reconstruction of the lower lip after total or subtotal amputation using the Webster's modification of the Bernard cheiloplasty -- advantages, disadvantages and limitations: three cases]. / Reconstruction post-traumatique de la lèvre inférieure après amputation totale ou subtotale selon la technique de Camille-Bernard modifiée Webster - avantages, inconvénients, limites : à propos de trois cas.

Webster's modification of the Bernard cheiloplasty is a well-known technique, usually applied to the reconstruction of total or subtotal amputations of the lower lip following oncological resection. We present three cases of post-traumatic reconstructions with interesting results.

Xantomas eruptivos: A propósito de dos casos familiares / Eruptive xanthomas: Two familial clinical cases

Se presentan dos pacientes de sexo masculino, familiares de primer grado, tabaquistas y etilistas severos, sin antecedentes patológicos conocidos. Ambos presentan en forma eruptiva la aparición de xantomas y uno de ellos una pancreatitis necrohemorrágica atribuida a su hipertrigliceridemia, complicación muy grave de este trastorno. Si bien los xantomas eruptivos no son muy frecuentes de observar, deben hacernos sospechar en una dislipidemia severa, confirmándola con una examen de laboratorio que pondrá de manifiesto una elevación significativa de los triglicéridos y frecuentemente alteración de los niveles de glucosa en sangre. Además, el estudio histopatológico de las lesiones mostrará macrófagos cargados de lípidos, de aspecto espumoso e infiltrado polimorfonuclear y mononuclear en dermis.

We report a case of two male patients, first-grade relatives, who are heavy drinkers and smokers but apparently have no pathological records. Both show eruptive xanthomas and one of them presents acute necrotic and hemorrhagic pancreatitis due to hypertriglyceridemia, a serious complication of this disorder. Despite the fact that eruptive xanthomas are not frequently observed, they should make us suspect an instance of severe dyslipidemia. In order to verify it, a laboratory test will show a dramatic raise of serum triglyceride levels and usual changes in the blood glucose levels. Moreover, a histopathologic study of the lesion will reveal macrophages full of lipids (foam cells) with polymorphonuclear and mononuclear infiltrate.

Dissociable face processing impairments after brain injury.

Matched populations of head-injured patients and normal control subjects completed three "forced-choice" face processing tasks designed to test facial expression recognition, familiar face recognition, and unfamiliar face matching. We hypothesised a significant difference in the performance of the patients and controls on the three tasks, and hoped to observe individual differences in the patients' performance across tasks. As predicted the head-injured patients made significantly more errors than the controls on the forced-choice tasks. Four cases of dissociable impairments affecting only one of the face processing tasks are reported; patient JP impaired only on facial expression recognition, patients AB and HI impaired only on familiar face recognition, and patient VS impaired only on unfamiliar face matching. These dissociable impairments provide further evidence for independent cognitive processing of specific face properties.

Physical rehabilitation of the old, old patient.

An increasing number of persons over the age of 85 are surviving acute illnesses and are being referred for physical rehabilitation. There have been no reports in the United States literature about the effectiveness of rehabilitation for this age group. Results of treatment of 97 patients (one hundred consecutive admissions) who were referred by four general hospitals to a suburban physical rehabilitation center were examined and the patients followed for six to 18 months. Seventy-nine per cent of the patients showed improvement, 18 per cent stayed the same, and 3 per cent worsened. Seventy-one per cent either returned to the same setting as before hospitalization or moved in with family members after treatment. These results show that well-planned rehabilitation is effective in the very old patient.