[Spiritual needs of patients in an emergency room]. / Spirituelle Bedürfnisse von Patienten eines Notfallzentrums.

BACKGROUND: Spiritual needs (spN) are important for human beings-independently of religious affiliation. They can be a resource for coping with stressful situations, e.g., those triggered by the acute onset of a disease. Emergency rooms are hospital departments with high medical performance which may cause a particular insecurity among emergency patients. The present study is the first to examine spiritual needs in a sample of patients in the emergency room. METHODS: A total of 383 out of 479 patients were approached and asked to complete the German version of the Spiritual Needs Questionnaire (SpNQ-20). All consented to the collection of demographics and clinical data. The analysis encompassed descriptive statistics, correlations analysis, univariate and multiple variance analysis. RESULTS: The needs for inner peace and generative needs (to pass something on to others, to do something for others) were more important than religious (rN) and existential (eN) needs. We did not find a correlation between spN on the one hand and the reason for consultation, the severity, and the number of comorbidities on the other hand. Age did not play a decisive role, rather, patients' needs, especially rN, were significantly more important among women than among men. CONCLUSION: Even in an emergency situation, people are ready to express their spN. Early assessment of these needs exposes important nonmedical aspects of the sick person and helps to consider the assessed needs. Further studies will show whether this has an impact on the further course of treatment and the well-being of the patients.

A prospective study of 100 cases of sterile T-RING™ digital tourniquet application.

The ideal finger tourniquet must be easy to use and provide a completely bloodless field with control of the pressure exerted at the compression site. The primary objective of this study was to evaluate the effectiveness of the T-RING™ digital tourniquet in emergency hand surgery; the secondary objective was to define the optimal indications and possible contraindications. This prospective study, undertaken between May 4 and July 30, 2015, comprised the application of 100 finger tourniquets in the following indications: all single or multiple digital wounds, distal from the base of the proximal phalanx, irrespective of their nature and the suspected structural damage. Data were collected with a questionnaire at the end of each surgical use of the finger tourniquet. An overall grade out of 30 was obtained by combining these scores. The facility of opening the packing was rated on average at 4/4, the facility of applying the finger tourniquet was rated at 3.8/4, the quality of the exsanguination at the beginning and at the end of the procedure were rated at 3.4/4 and 3.1/4, respectively, the difficulty related to positioning of the finger tourniquet was rated at 2.7/3, the facility of removing the finger tourniquet was rated at 3.6/4, the risk of forgetting the finger tourniquet at the end of the procedure was rated to 2.8/3, the comparison with an arm tourniquet was rated at 1.9/4. The overall grade was 25.1/30 on average. In current practice, use of the T-Ring™ tourniquet did not cause any difficulty. The tourniquet was never forgotten and the risk of forgetting it was considered low by the surgeons. The exsanguination appeared satisfactory, with a reduction in its effectiveness over time. We identified specific situations where its use could be indispensable: contraindication to trunk or plexus regional anesthesia, or as a relay to a pneumatic arm tourniquet after more than 2hours.

[Clubfoot's prenatal ultrasound diagnosis: is amniocentesis always warranted? About 124 cases]. / Diagnostic anténatal de pied bot : la réalisation d'une amniocentèse est-elle toujours justifiée ? À propos de 124 cas.

OBJECTIVES: Analyze factors leading to isolated clubfoot's occurrence, identify clubfeet associated pathologies, and discuss the opportunity of performing an amniocentesis in cases of isolated clubfoot. PATIENTS AND METHODS: Between January 2007 and December 2011, all patients diagnosed with clubfoot in our prenatal diagnostic center were retrospectively included. We then defined and analyzed idiopathic or isolated talipses equinovarus (ITEV) and clubfeet associated with others morphologic abnormalities or syndromic talipses equinovarus (STEV). RESULTS: One hundred and twenty-four clubfeet were analyzed. Forty-seven cases of ITEV, for which 34 caryotypes were performed with a normal result. Risk factors of ITEV in our series were male gender (P=0.0017), a family history of clubfoot (P=0.001) and primiparity (P=0.04). Seventy-seven cases of STEV were diagnosed, 14 of which had chromosomal abnormalities, 18 spina bifida and 10 musculo-skeletal abnormalities. Among the 124 cases of clubfeet, 25 were unilateral and 99 were bilateral. Bilateral talipses equinovarus do not constitute a risk factor of STEV (P=0.8). DISCUSSION AND CONCLUSION: We did not find any chromosomic abnormalities in cases of ITEV. The results of our study could lead to defer systematic amniocentesis in cases of primiparous women diagnosed with an ITEV, with a familial history of clubfoot and a male fetus. A referent echographist in prenatal diagnosis should still perform a systematic morphologic echography.

[Surgery for bronchogenic carcinoma in patients over seventy years old (author's transl)]. / La chirurgie du cancer broncho-pulmonaire chez les sujets de plus de 70 ans. A propos de 125 malades opérés.

125 patients aged over 70 years underwent operation for bronchogenic carcinoma at the Centre Chirurgical Marie Lannelongue for a period extending from 1963 to 1976. There were 123 male and 2 female patients. 112 had a squamous cell carcinoma. A total of 32 patients had a pneumonectomy performed, 86 a partial resection (lobectomy or bilobectomy) and 7 an exploratory thoracotomy. Post operative death was definitely higher (15,6%) in the pneumonectomy group than in the lobectomy one (2,6%). The main cause of post-operative death (62%) was pulmonary embolism. Post-operative complications were mainly related to cardiac arrhythmias. Overall survival rate after 5 years was 25,2%, slightly higher in the lobectomy group (25,9%) than in the pneumonectomy group (22,2%), higher in the differentiated squamous cell carcinoma group (31,1%) than in the undifferentiated (6,3%). The quality of life was reasonably satisfactory in most of the patients considering their age. Surgery for bronchogenic carcinoma in patients over 70 years old is recommended specially with limited resection is possible.

[Mediastinal surgery in children]. / La chirurgie du médiastin chez l'enfant.

From 96 surgical interventions in the child, the authors studied the repartition of tumours according to their histological nature, their benignity or malignancy. For each kind of tumour they gave its frequency and clinical, radiological and biological data. Above all they studied the distant results of these interventions with an important set back. The results are excellent for benign tumours and promising for malignant ones and enable the deduction of therapeutical indications.

[Anatomo-clinical calssification of primary tumors of the pleura and possibility of their surgical treatment]. / Classification anatomo-clinique des tumeurs primitives de la plèvre et possibilités du traitement chirurgical

A distinction is drawn between first category includes peduncolates, giant seslocal and diffuse primary tumours of the pleura on anatomopathological grounds. The first category includes peduncolated, giant sessile, and "deceptive" forms; the latter those in which the lung is surrounded by a "pleural" and "serous" mantle. Treatment is discussed and the soundness of surgical management is stressed.