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Saint-Michel-sur-Orge, France

Eguienta S.,Bordeaux University Hospital Center | Martigne L.,Center hospitalier dAngouleme | Dulucq S.,Bordeaux University Hospital Center | Fayon M.,Bordeaux University Hospital Center
Archives de Pediatrie | Year: 2015

The measurement of oxygen saturation by pulse oximetry (SpO2) is simple and fast. This non-invasive and widespread technique gives an indication of the oxygen level in arterial blood. While the method is reliable, there are limitations that can compromise the diagnostic procedure. The objective of the present paper is to list these limitations and discuss the precautions to be taken to optimize the interpretation of the results. Based on the case of a 3-year-old patient who presented with chronic hemoglobin oxygen desaturation, we discuss a decision-making algorithm in order to avoid unnecessary, expensive, and stressful investigations. © 2015 Elsevier Masson SAS.

Mesnier T.,Center hospitalier dAngouleme | Mimoz O.,University of Poitiers | Oriot D.,University of Poitiers | Ghazali D.A.,Service des urgences SAMU 86
Annales Francaises de Medecine d'Urgence | Year: 2015

Background: Emergency Medicine (EM) is a new specialty in France. Since 2004, the training is validated after obtaining an additional specialized diploma in EM. No studies have evaluated the training so far in France.Objectives: To assess the EM training program in France from the young physician’s perspective.Materials and methods: Opinion survey. A questionnaire assessing the theoretical and the practical training was sent between July and September 2014 by email to second year EM students in France. Five areas were discussed: profile of respondents, theoretical training, practical training, general training, future and questions about EM.Results: The response rate was 47%. The training was generally considered good by 79% of young physicians. 77% expressed that training had enabled them to improve their skills. The theoretical training was judged good by 69% of respondents but 56% felt the lack of practical training in two years. Training of many skills seemed insufficient and 99% thought it would be necessary to do more simulation trainings. Although satisfied with the training, only 40% would have chosen the EM program if it had existed at the beginning of their residency.Discussion: EM training in France should evolve to enhance it on a plane both theoretical and practical. It appears essential to increase the training and to practice teaching by simulation. This first national evaluation of EM training should be repeated to contribute to the evolution and the growth of our specialty. © 2015, Société française de médecine d'urgence and Springer-Verlag France.

Frossard B.,Hopitaux universitaires Paris Sud | Combret C.,Center hospitalier dAngouleme | Benhamou D.,Hopitaux universitaires Paris Sud
Annales Francaises d'Anesthesie et de Reanimation | Year: 2013

A patient presenting with paramyotonia congenita (Eulenburg's paramyotonia) was seen at the preanaesthetic visit during pregnancy. The underlying disease was known for years. Analysis of the literature and advice taken from specialists emphasized the safe use of regional anaesthesia and analgesia which was indeed used for labour and delivery without any complication. By contrast, the limited information available on the use of general anaesthesia suggests the risks associated with the use of succinylcholine and possibly with halogenated agents. Additional and useful factors that may limit the occurrence of myotonic crises such as maintenance of normal temperature and plasma potassium concentration, should be undertaken simultaneously. © 2013.

Cassou-Mounat T.,University Pierre and Marie Curie | Terroir M.,Medecine Nucleaire | Adam-Tariel F.,Center hospitalier dAngouleme | Perdrisot R.,Medecine Nucleaire | Biancheri-Mounicq I.,Center hospitalier dAngouleme
Medecine Nucleaire | Year: 2015

Purpose: Colorectal cancer is the third most common cancer in France while any age or sex. In 60 to 80% of cases, colorectal adenocarcinoma was developed from precancerous lesions, usually adenomatous. Screening allows early action limit the risk of metastatic cancer lesions. The aim of this study was to consolidate the importance to realize a colonoscopy in front of a colorectal focal uptake PET-CT. We would also try to show a correlation between the histology and SUVmax value. Materials and methods: This is a retrospective study from January 2010 to November 2012, bi-centric, involving 123 patients. All patients underwent PET-CT and colonoscopy next. During this period, about 6756 PET-CT realized, only 388 patients had PET-CT and colonoscopy. Patients have been included when PET-CT was before colonoscopy, and had no known colorectal cancer. Results: Out of 123 patients, we observed 136 suspect fixed focal uptake, among which 119 (87.5%) corresponded to 85 "polyps" (51 adenomas low grades, 16 hyperplastic polyps, 8 high-grade adenomas and 10 adenocarcinomas), 28 inflammatory, 5 metastasis, 1 lymphoma and 17 false positives. A statistically significant difference (P<. 0.001) was found between the adenocarcinomas SUVmax and the low-grade adenomas SUVmax. It also remained significant between groups recomposed with adenocarcinomas and high-grade adenomas vs. low-grade adenomas and hyperplastic polyps (P<. 0.001). It is found that 97.7% of lesions with a SUVmax greater than 10 were either adenocarcinoma or high-grade adenomas. Conclusion: This study confirms the importance of realizing a colonoscopy to explore an incidental focal colorectal 18F-fluorodeoxyglucose uptake. It also shows promising results to the SUVmax value for guide us on the histological severity and the urgency to make a colonoscopy. © 2015 Elsevier Masson SAS.

Bures E.,Service dAnesthesie | Rivet P.,Service dAnesthesie | Steiner T.,Service dAnesthesie | Stoll G.,Service dAnesthesie | And 3 more authors.
Douleurs | Year: 2011

The objective: This retrospective study is to determine the strong and weak points with CPNB continuous perinervous block for arteritis non-reconstructable patients. CPNB was performed with an increasing frequency concerning acute pain in postoperative analgesia. So far, the use of this analgesic technique has been reported neither for chronic pain nor for long duration. Methods: Locoregional anaesthesia was performed in surgical conditions. The pain score as well as the necessity for analgesics in complement was measured before and after CPNB. The benefits for limb healing were evaluated on 44 patients. Complications and adverse effects of this treatment were also followed up. Results: A significant improvement in pain relief on the 184 patients treated with 304 popliteal catheters was found between 2007 and 2009. The median time the catheter remained indwelling was 35. days. Patients' satisfaction was good or very good for over 80 %. Limb lesion amelioration was 31 %. Health cost reduction amounted to one million Euros per year. Infection was found in 9,7 %. Ablation catheter causes were reported. Conclusions: With CPNB, arteritis non reconstructable patients rather than postoperative ones are more likely to develop infection. But the treatment permitted to stop pain and implement protocols for nurses for arteritis lesions. This study shows that major chronic pains can be treated at home, over long duration, with important health cost reductions. © 2011 Elsevier Masson SAS.

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