Prognostic performance of early absence of pupillary light reaction after recovery of out of hospital cardiac arrest.

INTRODUCTION: Loss of pupillary light reactivity (PLR) three days after a cardiorespiratory arrest is a prognostic factor. Its predictive value upon hospital admission remains unclear. Our objective was to determine the prognostic value of the absence of PLR upon hospital admission in patients with out-of-hospital cardiac arrest. METHODS: We prospectively included all out-of-hospital cardiac arrests occurring between July 2011 and July 2017 treated by a mobile medical team (MMT) based on data from a French cardiac arrest registry database. PLR was evaluated upon hospital admission and the outcome on day 30. The prognosis was classified as good for Cerebral Performance Category (CPC) 1 or 2, and poor for CPC 3-5 or in case of death. RESULTS: Data from 10151 patients was analysed. The sensitivity and specificity of the absence of PLR for a poor outcome were 72.2% (71.2-73.2) and 68.8% (66.7-70.1), respectively. We identified several variables modifying the sensitivity values and the false positive fraction of a factor, ranging from 0.49 (0.35-0.69) for the Glasgow Coma Scale to 2.17 (1.09-2.48) for pupillary asymmetry. Among those living with CPC 1 or 2 on day 30 (n = 1990; 19.6%), 621 (31.2% (29.2-33.3)) had no PLR upon hospital admission. In the multivariate analysis, loss of PLR was associated with a poor outcome (OR = 3.1 (2.7-3.5)). CONCLUSIONS: Loss of pupillary light reactivity upon hospital admission is predictive of a poor outcome after out-of-hospital cardiac arrest. However, it does not have sufficient accuracy to determine prognosis and decision making.

Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France.

OBJECTIVE: Ensuring the availability of ultrasound devices is the initial step in implementing clinical ultrasound (CUS) in emergency services. In France in 2011, 52% of emergency departments (EDs) and only 9% of mobile intensive care stations (MICS) were equipped with ultrasound devices. The main goal of this study was to determine the movement of these rates since 2011. METHODS: We conducted a cross-sectional, descriptive, multicentre study in the form of a questionnaire. To estimate the numbers of EDs and MICS equipped with at least one ultrasound system with a confidence level of 95% and margin of error of 5%, 170 responding EDs and 145 MICS were required. Each service was solicited three times by secure online questionnaire and then by phone. RESULTS: Three hundred and twenty-eight (84%) services responded to the questionnaire: 179 (86%) EDs and 149 (82%) MICS. At least one ultrasound machine was available in 127 (71%, 95% CI [64; 78]) EDs vs. 52% in 2011 (P<0.01). 42 (28%, 95% CI [21; 35]) MICS were equipped vs. 9% in 2011 (P<0.01). In 97 (76%) EDs and 24 (55%) MICS, less than a half of physicians were trained. CUS was used at least three times a day in 52 (41%) EDs and in 8 (19%) MICS. CONCLUSION: Our study demonstrates improved access to ultrasound devices in French EDs and MICS. Almost three-quarters of EDs and nearly one-third of MICS are now equipped with at least one ultrasound device. However, the rate of physicians trained per service remains insufficient.

Ureteral reconstruction after renal transplantation: clinical outcome and risk factors.

INTRODUCTION: The incidence of urological complications after renal transplantation ranges from 2.5 to 30%. Often surgical revision is necessary. The risk factors for surgical revision and which surgical techniques to apply are not elucidated. This study investigates the outcome and risk factors for surgical revision of the ureterocystostomy. MATERIALS AND METHODS: Between January 1995 and March 2009, 1,157 consecutive kidney transplantations were performed. All patient charts and surgical reports were reviewed. RESULTS: Urological complications occurred in 142 (12.3%) patients. In 60 patients (5.2%) surgical revision was necessary. Of these 60 patients, 43 (71.7%) received neoureterocystostomy, 10 (16.7%) ureteropyelostomy reconstruction and 7 (11.7%) other techniques. Independent risk factors for surgical revision were donor ureteral reconstruction (odds ratio (OR) 48.66, 95% confidence interval (CI) 5.01-472.97), recipient age <18 years (OR 4.85, 95% CI 1.50-15.72) and delayed graft function (OR 2.70, 95% CI 1.36-5.36). Ureteral stenting was a protective factor for surgical revision (OR 0.30, 95% CI 0.12-0.81). The urological complication rates after neoureterocystostomy, ureteropyelostomy reconstruction and other techniques were 16, 0 and 0%, respectively. The overall surgical success rate was 92%. CONCLUSIONS: Ureteral stenting, recipient age, delayed graft function and perioperative ureteral reconstruction are significant factors associated with surgical revision of the ureterocystostomy. Surgical revision of the ureterocystostomy is a successful therapy with a low recurrence rate.

[National evaluation of knowledge and practice of cardiopulmonary resuscitation of children and infants in the field]. / Prise en charge préhospitalière de l'arrêt cardiaque de l'enfant et du nourrisson: enquête nationale de pratique.

INTRODUCTION: After the publication of new recommendations for cardiopulmonary resuscitation (2005 guidelines and 2006 French recommendations), we conducted a study amongst EMS teams concerning their approach with children and infants, nationwide. The objective was to measure the level of knowledge of guidelines and practice. METHODS: The online questionnaire was offered to emergency physicians belonging to the French emergency database, between November 1st and December 15th 2007. Incomplete questionnaires were excluded from the study. We recorded: profile of personnel, knowledge of guidelines, basic CPR and advanced CPR parameters. RESULTS: Four hundred and thirty-nine questionnaires were analyzed. Personnel was aged under 40 in 50.2 %, with 2-5 years experience in prehospital emergency care (57.6 %); 51,3 % declared having had training in pediatric CPR. A minority of subjects declared knowing the 2005 Guidelines (35 %), more the French 2006 recommendations (62.5 %). Basic CPR: transition age child/adult known in 30.3 %. Compression/ventilation ratio: 30/2 for one rescuer in 50.2 % (child), 46.5 % (infant); 15/2 for two or more rescuers in 57.6 % (child), 48 % (infant). AED age for use (1 year old) known in 59.8 %. Advanced CPR: epinephrine dose known in 89.3 % (intravenous) and 34.3 % (tracheal). External shock known in 57.2 %. CONCLUSION: This study emphasizes the lack of knowledge, especially with regard to first aid. Formations will be developed.

[Paratesticular rhabdomyosarcoma. Report of a case and review of the literature]. / Rabdomiosarcoma paratesticular. Aportación de un caso y revisión de la literatura.

Case report of an embryonary paratesticular rhabdomyosarcoma. The paper includes a literature review and discusses the current diagnostic, prognostic and therapeutic criteria analyzing in detail the current role of retroperitoneal lymphadenectomy and the value of adjuvant radiotherapy or chemotherapy.

[Endoscopic surgery of bladder diverticulum]. / Cirugía endoscópica del diverticulo vesical.

OBJECTIVE: To assess the endoscopic treatment of a vesical diverticulum by incision of the diverticulum opening and mucous fulguration associated to infravesical deobstructive surgery. METHOD: The procedure was performed in 30 male patients with flowmetry-documented infravesical obstruction. Results were radiologically evaluated, with patients being assigned to one of 3 groups: diverticulum disappearance; size reduction greater than 50% and persistence or size reduction lower than 50%. RESULTS: Disappearance of diverticulum was verified in 15 patients, size reduction greater than 50% in 9 patients, and persistence or size reduction lower than 50% in 6 patients. The complications rate in this series was 6.6%. CONCLUSIONS: Endoscopic treatment of a vesical diverticulum with the technique used in our series, was shown to be effective, particularly in diverticula with diameter under 50 mm, and was associated to low morbidity and short hospital stay.

[Endoscopic lithotripsy by means of Lithoclast]. / Litotricia endoscópica mediante Lithoclast.

OBJECTIVES: We evaluated the efficacy of endoscopic pneumatic lithotripsy with the Lithoclast for urinary tract calculi. The use of this stone disintegration system and the possible complications are described. METHODS: We performed a retrospective analysis of the results achieved in the first 100 patients (156 stones) that had been treated with this system at different sites. The patients were evaluated radiologically early postoperatively and throughout follow up (mean 12 months). RESULTS: Stone fragmentation could not be achieved in three patients, the only failures. The early postoperative assessment showed residual stones in 13% of the patients; 5 patients spontaneously passed the stone remnants and 8% had stone remnants on radiological evaluation during follow up. The only remarkable complication was a perforated ureter which required no surgery. CONCLUSIONS: In our experience, the Lithoclast lithotripsy system is effective at any level of the urinary tract. It has a low complication rate and is simple and low-cost.

[Endoscopic biopsy in the staging of infiltrating tumor of the bladder]. / La biopsia endoscópica en el estadiaje del tumor vesical infiltrante.

From July, 1990 to June, 1991, a prospective study was conducted on 65 patients with infiltrating bladder tumor to determine the possibility of distinguishing T2 from T3 tumors endoscopically. Sixty-six tumors were resected, including all of the bladder wall, and samples of perivesical fat were obtained from the tumor bed. The pathologist found infiltration of the bladder muscle wall in 50 cases (75.6%) and classified 12 tumors as T2 and 38 as T3. Fifty-five per cent of the T3a tumors were reclassified as T3b on the basis of the indirect signs of the pelvic scan and bimanual palpation performed under anesthesia. The clinical staging correlated with the pathological findings in 52.6% of the 19 cases of pT3b that underwent radical cystoprostatectomy; 31.7% of the pT3b tumors were clinically understaged, mainly due to prostatic infiltration. We can conclude from our findings that the differential diagnosis between pT2 and pT3 tumors is possible by endoscopic resection for most of the infiltrating bladder tumors; however, pT3a tumors cannot be distinguished from pT3b tumors with sufficient reliability.

[Drug-induced fever caused by prophylactic isoniazid in bladder instillations with BCG]. / Fiebre farmacológica por isoniacida profiláctica en instilaciones vesicales con BCG.

We present of one patient with isolated pharmacological fever probably caused by Isoniazid given prophylactically 24 hours prior to each vesical instillation with BCG as maintenance therapy for in situ vesical carcinoma. The fever appeared in two occasions before the instillation and did not returned once the drug was discontinued. We Review this adverse effect which may lead to diagnostic error.