Oleofoams: Properties of Crystal-Coated Bubbles from Whipped Oleogels-Evidence for Pickering Stabilization.

Interfacially stabilized nonaqueous lipid-based foams, which we name here oleofoams, are rarely encountered as opposed to the large number of aqueous foams stabilized by molecular or particulate emulsifiers. There is no case well described in the literature with a convincing characterization of the interfacial contribution to oleofoam stability. Methods for filling this gap are described here, which reach out to a large part of the lipid phase diagram. We bring here complete evidence that lipidic crystals made of a high fraction of fully soluble monoglyceride (MG) in oil do not only adsorb at the oil-air interface but also can easily form a jammed, closely packed layer of crystals around the bubbles of a foam produced by whipping (Pickering effect). Very fine bubbles, soft textures, or firmer ones such as for shaving foams could be obtained, with a high air fraction (up to 75%), which is unprecedented. A thin, jammed layer of crystals on bubbles can cause bubbles to retain nonspherical shapes in the absence of bulk effects for times much longer than the characteristic capillary relaxation time for bare bubbles, which is actual evidence for Pickering-type interfacial stabilization. By comparing to foams obtained by depressurization, we show that whipping is necessary for bubble wrapping with a layer of crystals. The origin of high stability against Ostwald ripening at long times is also discussed. Furthermore, we show that these Pickering whipped foams have rheological properties dominated by interfacial or film contributions, which is of high interest for food and cosmetics applications because of their high moduli. This system can be considered to be a model of the crystallization behavior of MG in oil, which is similar to that in many fats. Our methods are very general in the context of lipid-based foaming, in particular, from food materials, and were used in patent applications.

[Risks acceptability related to obstetrical epidural analgesia]. / Acceptabilité des risques associés à la mise en place d'une analgésie péridurale obstétricale.

OBJECTIVES: Evaluation of the acceptability of complications related to obstetrical epidural analgesia in two populations, parturients and anesthesiologists. STUDY DESIGN: Prospective, transversal, single center study. MATERIALS AND METHODS: Evaluation of the acceptability of complications associated with obstetric epidural analgesia performed using a questionnaire of six clinical scenarii in two populations: parturients cared at the University maternity of Nancy and anesthesiologists of Lorraine. Patients were interviewed by an anesthesiologist, physicians via Internet. Acceptability was assessed using two tools, the absolute acceptability with a visual analog scale and the relative acceptability obtained by classifying clinical scenario against each other, in ascending order of acceptability. RESULTS: One hundred and forty-six parturients and 87 anesthetists assessed the acceptability of the different scenarios. The three less serious scenarios (hypotension, failure, dural tap) were acceptable for both populations. One case (spinal hematoma) was unacceptable for parturients. Three cases of varying severity (failure, dural tap, plexus injury with sequelae) were judged significantly less acceptable by patients than physicians (5.9 vs. 7.9 [P<0.001], 5.75 vs. 8.1 [P<0.01], 4.1 vs. 5.1 [P=0.035]). Multivariate analysis did not show any predictive factor of acceptability in both populations. CONCLUSION: In this study, the overall acceptability of the inherent complications of epidural analgesia was good in the two populations. It was essentially based on the notion of severity and preventability. A large interindividual variability was observed and a better acceptance by the anesthesiologists.

[Percutaneous umbilical blood sampling in pregnant women with thrombocytopenia. Apropos of 35 cases]. / Ponction de sang foetal au cours des thrombopénies de la femme enceinte. A propos de 35 cas.

OBJECTIVE: To determine the interest of percutaneous umbilical blood sampling in maternal thrombocytopenia. PATIENTS AND METHOD: We performed a retrospective study of 36 percutaneous umbilical samples in pregnant women with thrombocytopenia. We included patients with a platelet count less than 100,000/mm(3) or a previous diagnosis of idiopathic thrombocytopenic purpura. Patients were divided into two groups. Group A consisted of women whose thrombocytopenia was caused by idiopathic thrombocytopenic purpura. The other patients were included in the group B. Percutaneous umbilical blood samples were performed by direct ultrasound guidance under sterile conditions, after 37 weeks gestation. Cesarean section was indicated if the fetal platelet count was < or =50 000/mm(3), in other cases obstetric indications were followed. RESULTS: Percutaneous umbilical blood samples were performed at a mean age of 38.5 gestational weeks. Fetal blood sampling was successful in 34 of the 36 cases. There was no fetal complication. In group A, two fetuses had low cord-blood platelet counts (20,000 and 98,000 per cubic millimeter). There was no fetal thrombopenia in group B. Three cesarean sections were performed, in one case because of severe fetal thrombocytopenia and in 2 cases because of an unsuccessful percutaneous umbilical blood sampling (in both, neonatal platelet count was normal). There was no significant complication in infants. There was a significant correlation between fetal and neonatal platelet count. CONCLUSION: There is no maternal predictive factor for fetal thrombocytopenia. Percutaneous umbilical blood sampling is feasible and has a good diagnostic value. The overall risk of fetal loss is low. But there is no indication of percutaneous umbilical blood sampling in the management of thrombocytopenia in pregnancy because severity of thrombopenia is not directly related to the severity of maternal disease and there are no series large enough to assess the association between delivery method and intracranial hemorrhage in thrombocytopenic infants born of mothers with idiopathic thrombocytopenic purpura. More subjectively than on scientific arguments a percutaneous umbilical blood sampling could be performed for patients with idiopathic thrombocytopenia purpura and a past history of neonatal intracranial hemorrhage. A cesarean section could be done if the platelet count is less than 100 000/mm(3), no intracranial hemorrhage has been described above this level.

[Multicystic neonatal encephalopathy after a traffic accident with minor maternal injuries]. / Encéphalopathie multikystique néonatale après accident de la voie publique avec lésions maternelles mineures.

We report a case of traffic accident at 30 weeks of gestation. The maternal injuries were minor. The fetal heart rate patterns showed tachycardia and decreased modulation. Ultrasound scanning was normal, without abruptio placentae. Ten days after the accident, a cesarean section was done on altered fetal heart rate with a normal infant at birth. This baby died 17 days latter from an ischemic multicystic encephalomalacia. With the view of the literature, we try to explain the pathophysiological mechanism of this severe fetal outcome despite minor maternal injuries. Hypovolemic collapsus, caval syndrome and maternal stress could be the cause of placental hypoperfusion. Abruptio placenta and feto-placental hemorrhage are others explanations. We propose the management for first aid workers and the specialized unit care.

Nursing informatics in a registered nurse graduate program.

For many Registered Nurses the question is not whether to advance their education, but how to attain the requisite formal learning experiences given their professional and personal responsibilities. One innovative approach to facilitating the pathway to graduate education for a group of very experienced nurses lacking the BSN is the RN-MS Program at Northeastern University. This graduate-level curriculum provides an opportunity for selected Associate Degree and Diploma prepared nurses to integrate their basic nursing education, extensive clinical practice, professional leadership experience, and practical knowledge base within an extended (85 quarter hours) formal graduate program of study in a nursing specialization. The learning paradigm includes Nursing Informatics and computer competency. The intent of this work was to analyze the experience of RN applicants--students who participated in the faculty designed seminar and developed a typed portfolio using word processing software as part of the admission process in the RN to MS Program. The Nursing Informatics (computer competency component) and its integration throughout the curriculum will be evaluated.

Integration of nursing informatics in a registered nurse graduate program.

Experienced registered nurses (RNs) are adult learners seeking a program of study in many academic settings to prepare for the advanced practice nursing role. They want a visionary curriculum that builds on their previous experience and develops their creativity in meeting educational goals and objectives [1]. At the Northeastern University College of Nursing in Boston such a program exists. Building on their first foundation course, Professional Development Seminar, RN students are exposed to the Benner Model, From Novice to Expert [2].

[Nasopharyngeal cancer and pregnancy. Review of the literature. Report of a case]. / Cancer du cavum et grossesse. Revue de la littérature. A propos d'un cas.

We present a case of a rare condition of nasopharyngeal cancer and pregnancy occurring together. We review the unusual epidemiological, clinical and prognostic features of this type of cancer. Because of the immunological changes that occur in pregnancy and because of the potential oncogenic role of Epstein Barr virus we consider that pregnancy worsens the prognosis for nasopharyngeal cancer. After having pointed out the risks of radiotherapy and particularly of chemotherapy in pregnancy, we discuss the need to carry out a therapeutic abortion because of the effect that pregnancy will have if it is allowed to go on to term.

[Resistance to contraception]. / La résistance à la contraception.

While contraception has been an acquired freedom for more than 10 years, a number of women present clinical manifestations resulting in the restriction or the suppression of this freedom. The symptoms are extremely diversified, from forgetting the pill to severe depression, from repeated infections to personality disorders. If many symptoms may be explained from an organic standpoint, others only derive from an unconscious resistance to contraception. The authors attempt to determine the origins of such resistance, their possible variations and advocate a management protocol for patients presenting this type of disorder.

PIP: A discussion of unconscious psychological resistance to contraception is illustrated by the case of a woman with a 10-year history of use of oral contraceptives and IUDs marked by repeated development of side effects and changes of formulation culminating in a serious depression after tubal ligation at age 35. The woman's postligation complaints of abdominal pain resistant to analgesic treatment were the expression of a serious depressive syndrome that responded poorly to antidepressants. The request for contraception normally contains 2 propositions: the individual desires to have sexual relations, and the individual does not wish to procreate. The logical connection between these 2 propositions at the conscious level is absent at the level of the unconscious, where there is no logic or possibility of reasoning. Forgetting a pill is a relatively minor form of resistance to contraception. Other symptoms, such as pain, vertigo, nausea, nervousness, insomnia, and anxiety with the pill or unexplained pain, repeated local infections, or anxiety and depression with the IUD may be manifestations of the psychological modifications inevitably caused by the psychic symbolism of the contraceptive. The difficulty experienced by certain women in accepting in their unconscious the 2 propositions about contraception causes the symptoms to be produced. Unconscious motives for resistance to contraception may include a woman's dependence on the potential for maternity for her sexual identity, or anxiety at the degree of sexual freedom offered by the contraceptive method. The unconscious elements related to resistance are sometimes open to modification. A study of women undergoing abortion at a center in Rennes indication that 91% failed to use an effective method of contraception at the time of the pregnancy, but that 1 year later 76% had accepted a method. Only 12% at risk of undesired pregnancy were not using a method. A large part of the increased usage was probably explained by contraceptive information provided at the time of the abortion, but the very fact of the abortion may have helped some of the women resolve their feelings of ambivalence about contraception. But 53% of the contraceptive acceptors complained of side effects, mainly anxiety, decreased sexual pleasure, weight gain and menstrual problems. It appears that an abortion may influence the decision to use a method without greatly changing the resistance to contraception. The practitioner wishing to assess the potential tolerance or resistance of a woman to contraception should take the time to discuss her feelings about contraception, menstruation (which signifies absence of pregnancy and thus maternity), and her sexual and emotional life. the dialogue can continue in subsequent visits if the women had complaints about side effects.

[Circumstances in the detection of carcinoma in situ of the breast. Apropos of 12 cases]. / Les circonstances de découverte des carcinomes in situ du sein. A propos de 12 cas.

In France, 7,000 women die yearly of cancer of the breast, and 25,000 new cases are registered. The seriousness of the illness and its frequency show how important it is to diagnose it early at a stage before invasion or in situ (where 95 to 100% can be cured). In 4 years, at the University Hospital of Rennes, 90 out of 446 patients who were operated on for breast lesions had invasive cancer of the breast, i.e. 20%. 12 had a carcinoma in situ of the breast (C.I.S.E.), constituting 2.6%, of which 9 were in situ duct carcinomas and 3 in situ lobular carcinomas. In situ carcinoma of the breast can take almost any clinical form (a nodule, pain in the breast, mastitis, blood stained discharge from the nipple or Paget's disease). This means that lobular carcinoma in situ is always a surprise when diagnosed histologically in a lesion that is clinically benign. Since the anatomo-pathological diagnosis is difficult, a simple examination of the breast is not to be relied on in cases of carcinoma in situ of the breast. Mammography is the only truly valuable investigation in early diagnosis of C.I.S.E.

[Contraception a year after voluntary interruption of pregnancy]. / Contraception un an après une interruption volontaire de grossesse.

At the time of conception leading to a RLA, 94 percent of the women were not using medical contraception (intra-uterine contraceptive device or estroprogestin drug). One year after the RLA, only 12 percent of the patients were found not to be using medical contraceptives. Thus, RLA is an event which modifies considerably the contraceptive habits of the patients. It is remarkable that one year after a RLA, 3/4 of the patients continue to use the contraceptive prescribed immediately after RLA.

[Medico-legal risks of human voluntary sterilization]. / Les risques médicolégaux de la stérilisation volontaire humaine.

PIP: There has been no legislation in France explicitly authorizing voluntary sterilization, so that a practitioner carrying out a voluntary surgical sterilization runs a theoretical risk of lawsuit. Concern about the legal status of voluntary sterilization stems from 2 articles in the French penal code, article 16 which forbids the crime of castration, defined as the intentional complete and definitive amputation or removal of an organ necessary for procreation; and article 309 which forbids voluntary assault and battery resulting in death or inability to work for 8 days, or a lesser incapacity if the violence was premeditated. Vasectomy and tubal ligation differ from castration in that they do not involve removal or mutilation of the genital organs. Article 309 has been applied to a sterilization case only once. The criminal chamber of the Court of Cassation, France's highest appeals court, ruled in 1937 that the consent of the victim had no effect on penal responsibility, since individuals have no right to violate on their own persons the rules of public order by undergoing corporal injuries unjustified by medical need. There has been no penal judgment since 1937 in a voluntary sterilization case. In a 1983 judgment, the Court of Cassation upheld the responsibility of a surgeon for not informing a 28-year-old mother of 5 of the possibility of failure of the sterilization operation he performed on her. The patient found herself pregnant once again less than 1 month after the operation. Had she been informed of the possibility of pregnancy, she might have taken further precautions to avoid it. The court established a causal link between the problems created by the pregnancy and the fault of the physician in not providing adequate information. The court's decision was of interest because it included tubal ligation among surgical interventions condoned by the common law of medical responsibility, thereby implying acceptance of voluntary sterilization. The plaintiff brought the action in civil rather than criminal court, and the question of the legal status of the operation was not raised even though the operation was not performed to remedy any pathological condition. The Court of Cassation was careful to specify that the surgeon had an obligation to use appropriate techniques according to state of the art procedures to obtain sterilization. The surgeon's error was not failure of the operation but failure to warn the patient of the possibility of pregnancy.^ieng

[Amniotic fibronectin in normal pregnancy and pregnancy with fetal anencephaly]. / Fibronectine amniotique au cours de grossesses normales et de grossesses avec anencéphalie foetale.

Fibronectin, which is an important protein in plasma and in surface cells was calculated in amniotic fluid using a laser ray nephelemetric technique. In normal pregnancies (in 72 samples studied) this protein which rises towards the 18th week of amenorrhoea (mean +/- S.D.: 60.8 +/- 16.0 mg/l), decreases steadily to term (mean 14.8 +/- 8.9 mg/l). In fetal anencephaly (10 samples tested) high levels were also found but the difference as compared with normal levels was not significant. This measurement does not therefore constitute an extra way of screening for closure of the neural tube.

[Maternal death of obstetrical origin. Medicolegal aspects]. / Mort maternelle d'origine obstétricale. Aspects médico-légaux.

The authors have become interested in maternal mortality. This study has been carried out solely to look at the medico-legal aspect. Increasingly good health is seen as a right and the doctor the dispenser of this service. The rights of the mother (and of the infant) become of increasing importance. The improvement in obstetrical techniques, which are much better known to the public, have made families far more confident of the results of delivery. This is now seen as something without any danger. But delivering a baby still has lots of risks. Because of this, if an accident happens the obstetrician more than any other doctor perhaps can find himself in the courts. To avoid this he has to know very well the causes of maternal mortality in order to avoid them as far as possible. Furthermore, he must not undertake stupid emergency measures often initiated as measures of desperation caused by his emotional involvement for a patient who is approaching death. Finally, the expert should look for all the causes of death so that he does no wrongly blame the doctor for a maternal death.

Rupture of the uterus during labor without apparent cause.

Spontaneous uterine rupture at term during labor of a non-scarred uterus under epidural anaesthesia is reported in a 17-yr-old primigravida. This exceptional event may lead to catastrophic maternal and fetal consequences. The authors discuss the prevention and diagnosis of this obstetrical complication.

[Repair of duodenal defects by a pedunculated jejunal flap. Experimental study in the dog (author's transl)]. / Réparation des brèches duodénales par patch jéjunal pédiculé. Etude expérimentale chez le chien.

The authors operated 18 dogs on whom they carried out a large duodenal defect which was then repaired, in the same operation, by an open pedunculated jejunal flap. They studied the progress of this flap and the quality of the duodenal repair. After about 4 months, on average, the animals were re-operated to check the quality of the repair and to see if the vascular peduncle could be cut. Section of the vasculature was well tolerated because of the development of very small vascular anastomoses.

[Hydramnios and fetal malformations. A consecutive series of 50 cases which were under observation in the maternity unit of C.H.U. of Rennes between 1971 and 1978 (author's transl)]. / Hydramnios et malformations foetales. A propos d'une série continue de 50 cas observés à maternité du C.H.U. de Rennes de 1971 à 1978.

50 cases of hydramnios were found in 17,528 deliveries. This gives a percentage of 0.29. These 50 cases of hydramnios gave birth to 53 fetuses which showed one or more of the following abnormalities. 20 malformations of which 12 were of the central nervous system; 6 twins; 6 cases of Rhesus allo-immunisation; 1 case of chorio angioma; 4 unexplained intra-uterine deaths; and 27 infants that died later. No etiological cause for this hydramnios was found in 20 cases. There was no maternal pathology to be found. Often the obstetrical histories of these women are pathological. In 3 per cent of the cases there was a previous abortion and in 18 per cent it appeared that there was previous hydramnios. We discuss what measures should be taken in cases of hydramnios. In our opinion a woman who has had a pregnancy with hydramnios should have genetic counseilling. The combination of hydramnios with delayed intra-uterine growth suggests that fetal malformation is present.