[Efficiency and safety of recombinant activated factor VII in a case of severe postpartum hemorrhage]. / Efficacité et tolérance du facteur VIIa recombinant dans l'hémorragie grave du post-partum: à propos d'un cas et revue de la littérature.

We report the case of a severe postpartum hemorrhage (PPH) that was successfully treated with two administrations of recombinant activated factor VII (rFVIIa). Two major thromboembolic events (TEE) occurred shortly afterwards: the first was an acute lower limb ischemia at H3, the second was a cardiac arrest complicating a massive pulmonary embolism on day 5. Fortunately, both events had a favorable outcome. This case report allows us to discuss the role of rFVIIa during severe PPH and its potential responsibility in these two major TEE.

[Assessment of quality in day-case hand surgery]. / Démarche d'assurance qualité en chirurgie ambulatoire de la main.

OBJECTIVE: To determine the level of satisfaction in terms of pain relief and comfort among patients receiving different postoperative analgesia protocols after hand surgery under regional anaesthesia in a day care unit. METHODS: Cohort study among patients after hand surgery under regional anaesthesia during two consecutive three months time periods, with patient stratification according to the expected pain level with different balanced analgesia protocols (group A: carpal tunnel, group B: other surgery without bone involvement, group C: bone surgery). A telephone survey, scoring analgesia and comfort, each with a numerical (0-10) scale was conducted on days 1 and 7. During the first period analgesia for groups A and B was the same (acetaminophen-dextropropoxyphene or acetaminophen-codeine) and group C patients were treated with acetaminophen-ketoprofen-tramadol. In the second period analgesia was reduced for group A (acetaminophen alone) and increased for group B (acetaminophen-ketoprofen-tramadol) and group C (duration increased from 3 to 7 days). RESULTS: For carpal tunnel surgery, analgesia with acetaminophen alone was efficient, (Pain scale [PS] d0=2[0-10], PS d1=1 [0-10] and PS d2-d4=0,5 [0-10]). This surgery does not elicit important pain, there is no benefit in adding other analgesics. For group B, a significant improvement in postoperative pain was observed (postoperative d1 p<0.03) with a major increase in side effects (2/57 vs 17/48 p<0.001). For group C, therapeutic changes were ineffective (PS d0=2 vs 3.5 et PS d1=3 vs 5 [NS]) and we noticed an increase in side effects (p<0.05). One third of all patients are totally satisfied on day 7, logistic regression showing the role of inefficient analgesia in late postoperative period (PS>2 between d2-d4). Between day 1 and day 7, 20% of the patients change their point of view, those who feel less satisfied on day 7 complained of a more severe postoperative pain between day 2 and 4 (p<0.001) and between day 5-7 (p<0.01). CONCLUSION: For hand surgery on day case, quality of late postoperative analgesia (day 2-day 7) is strongly related to patient's satisfaction on day 7.

Quantification of intervertebral efforts during walking: comparison between a healthy and a scoliotic subject.

The accurate quantification of internal efforts in the human body is still a challenge in biomechanics. The aim of this study is to quantify the intervertebral efforts along the spine during walking, in order to compare the dynamical behaviours between a healthy and a scoliotic subject. Practically, one healthy subject, one scoliotic patient before an instrumentation surgery (Cobb 41 degrees ) and after this instrumentation (Cobb 7.5 degrees ) walked on a treadmill at 4 km/h. The acquisition system included optokinetic sensors, recording the 3D-joint coordinates, a treadmill equipped with strain gauges, measuring the external forces independently applied to both feet, and bi-planar radiographs, enabling the 3D reconstruction of the spine from C7 to L5, using a free form interpolation technique. The intervertebral efforts were computed using an inverse dynamical model of the human body in 3D. As results, significant differences of the spine kinematics were recorded which lead to different internal effort behaviour in magnitude, shift, coordination and pattern when normalized to the subject mass. Particularly, the normalized antero-posterior intervertebral torques are less uniform for the scoliotic patient (from min -2.5 to max 1.9 Nm/kg) than the healthy subject (from -1.5 to 1.5 Nm/kg). This disequilibrium in the left-right balance of the scoliotic patient is a bit rectified after surgery (from -1.3 to 1.1 Nm/kg).