Port-Louis, France
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Chiniard T.,Ecole du Val de Grace | Naulet P.,Service dimagerie medicale | Chai M.,Service daccueil des urgences
Journal Europeen des Urgences et de Reanimation | Year: 2017

Cockett syndrome is an anatomic variation characterized by the compression of the left common iliac vein by the right common iliac artery, of whom clinical presentation can be deep venous thrombosis, mostly on the left side, or chronic venous insufficiency signs. Case report: A 65-year-old woman presented at the Emergency Department with a clinical presentation of "big red leg". Biologic examinations and CT scan found an extensive deep venous thrombosis in the left inferior limb due to Cockett syndrome, associated with a pulmonary embolism. Discussion: Diagnosis of thrombosis due to Cockett syndrome should be managed with a rigorous manner that is not significatively different from a classical deep venous thrombosis. Although the treatment is not standardized, the major topic is the orientation of that kind of patient to a vascular medical-surgical facility as soon as possible. Conclusion: Cockett syndrome should be known and evoked in the ER. © 2017 Elsevier Masson SAS.


Fiole D.,Institute Of Recherche Biomedicale Des Armees | Fiole D.,Joseph Fourier University | Fiole D.,University of California at Los Angeles | Deman P.,Institute Of Recherche Biomedicale Des Armees | And 9 more authors.
Infection and Immunity | Year: 2014

The dynamics of the lung immune system at the microscopic level are largely unknown because of inefficient methods of restraining chest motion during image acquisition. In this study, we developed an improved intravital method for two-photon lung imaging uniquely based on a posteriori parenchymal tissue motion correction. We took advantage of the alveolar collagen pattern given by the second harmonic generation signal as a reference for frame registration. We describe here for the first time a detailed dynamic account of two major lung immune cell populations, alveolar macrophages and CD11b-positive dendritic cells, during homeostasis and infection by spores of Bacillus anthracis, the agent of anthrax. We show that after alveolar macrophages capture spores, CD11b-positive dendritic cells come in prolonged contact with infected macrophages. Dendritic cells are known to carry spores to the draining lymph nodes and elicit the immune response in pulmonary anthrax. The intimate and long-lasting contacts between these two lines of defense may therefore coordinate immune responses in the lung through an immunological synapse-like process. © 2014, American Society for Microbiology.


Migliani R.,Ecole du Val de Grace | Pradines B.,Institute Of Recherche Biomedicale Des Armees | Pradines B.,Aix - Marseille University | Michel R.,Center Depidemiologie Et Of Sante Publique Des Armees | And 5 more authors.
Travel Medicine and Infectious Disease | Year: 2014

Each year, 40,000 French soldiers deploy or travel through malaria-endemic areas. Despite the effective control measures that were successively implemented, malaria remains a public health concern in French armed forces with several important outbreaks and one lethal case every two years. This article describes the malaria control strategy in French armed forces which is based on three combined strategies: i) Anopheles vector control to prevent infection with the implementation of personal protection against vectors (PPAV) adapted to the field living conditions of the troops. ii) Chemoprophylaxis (CP) to prevent the disease based on prescription of effective and well tolerated doxycycline. iii) Management of cases through early diagnosis and appropriate treatment to prevent death. In isolated conditions in endemic areas, rapid diagnosis tests (RDT) are used as first-line tests by military doctors. Treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria is based either on the piperaquine tetraphosphate-dihydroartemisinin association since 2013, or on the atovaquone-proguanil association. First-line treatment of severe P. falciparum malaria is based on IV artesunate. These measures are associated with constant education of the military, epidemiological surveillance of malaria cases and monitoring of parasite chemosensitivity. © 2013 Elsevier Ltd. All rights reserved.


PubMed | Ecole du Val de Grace and Institute Of Recherche Biomedicale Des Armees
Type: Journal Article | Journal: Muscle & nerve | Year: 2016

As skeletal muscle mass recovery after extensive injury is improved by contractile activity, we explored whether concomitant exercise accelerates recovery of the contractile and metabolic phenotypes after muscle injury.After notexin-induced degeneration of a soleus muscle, Wistar rats were assigned to active (running exercise) or sedentary groups. Myosin heavy chains (MHC), metabolic enzymes, and calcineurin were studied during muscle regeneration at different time points.The mature MHC profile recovered earlier in active rats (21 days after injury) than in sedentary rats (42 days). Calcineurin was higher in the active degenerated than in the sedentary degenerated muscles at day 14. Citrate synthase and total lactate dehydrogenase (LDH) activity decreased after injury and were similarly recovered in both active and sedentary groups at 14 or 42 days, respectively. H-LDH isozyme activity recovered earlier in the active rats.Exercise improved recovery of the slow/oxidative phenotype after soleus muscle injury. Muscle Nerve 55: 91-100, 2017.


Auxemery Y.,Ecole du Val de Grace | Auxemery Y.,University Paris - Sud
Medical Hypotheses | Year: 2012

Post traumatic stress disorder (PTSD) is a complex and heterogeneous disorder, which specific symptoms are re-experiencing, increased arousal and avoidance of stimuli associated with the trauma. PTSD has much comorbidity like depression, substance abuse, somatic complaints, repeated dissociative phenomena and transitory or chronic psychotic reactions. PTSD can manifest itself in different clinical forms: some patients present higher symptoms in one domain as compared to another, probably because of abnormalities in different neurobiological systems. Hyposerotonergic and hypernoradrenergic PTSD endophenotypes have been previously identified and the purpose of this paper is to focus on the hypothesis of a hyperdopaminergic endophenotype. The current review discusses several entities: PTSD with psychotic features with or without depression, the comorbide use of psychoactive substances that increase psychotic symptoms and traumatic brain injuries as agents of psycho traumatic and psychotic features. For all of these nosographic entities, the dopaminergic neuromodulation may play a central role. The hypothesis of a hyperdopaminergic endophenotype of PTSD opens up new research and therapeutic perspectives. Although antipsychotics are frequently used for people with PTSD further studies are needed to develop a consensus on the guidelines for treating the psychotic forms of PTSD. © 2012 Elsevier Ltd.


PubMed | Coordination nationale pour la lutte contre le virus Ebola en Guinee, Ecole du Val de Grace, Centers for Disease Control and Prevention and Organisation mondiale de la sante
Type: Journal Article | Journal: Bulletin de la Societe de pathologie exotique (1990) | Year: 2016

Ebola Zaire species variant Makona between its emergence in December 2013 and April 2016, resulted in an epidemic of Guinea importance and unprecedented gravity with 3814 reported cases of which 3358 were confirmed (88.0%) and 2544 were died (66.7%). The epidemic has evolved in phases: a silent phase without identification of all fatal cases until February 2014; a first outbreak from March 2014, when the alarm is raised and the virus detected, which lasted until July 2014; a second increase, which was the most intense, from August 2014 to January 2015 focused primarily on the forest Guinea; and a final increase from February 2015 centered on lower Guinea and the capital Conakry. Adapting strategies in 2015 (initiative Zero Ebola in 60 days active case search and suspicious deaths and awareness of active prefectures, microbanding the last affected communities and raking around these localities) and ring vaccination of contacts around confirmed cases has allowed to gradually control the main outbreak in October 2015. But a survivor was originally resurgence in forest areas between March and April 2016 with 10 cases including 8 deaths. The epidemic has particularly affected the forest Guinea region (44% and 48% of Guinean cases and deaths), elderly women ( 50 years), and health professionals (211 cases including 115 deaths); however, almost one-third of the patients (32.6%) was not provided supportive care in the Ebola centers. The epidemic is currently marked by the resurgence of small foci, from excreting subjects cured of the virus who have been controlled so far successfully. The survivors are the subject of special attention. It is necessary to learn lessons from the response to better prepare for the future, to improve knowledge about the natural history of the Ebola virus disease, and to rethink communication in this regard with the public and its leaders.


PubMed | Hopital de Ninefecha, Laboratoire Of Parasitologie, PNLB, Ecole du Val de Grace and Le Kaicedrat
Type: Journal Article | Journal: Bulletin de la Societe de pathologie exotique (1990) | Year: 2016

The authors report the results of controlling schistosomiasis in 53 villages from Ninefecha area-(Kedougou District, East Senegal) within Schistosomiasis National Control Program partnership. The four aims were: i) praziquantel treatment of 3324 children 6-14 years old, ii) installation of a laboratory for children prevalence annual monitoring (random draw one in three), iii) health education of the concerned people (sensitization), iiii) construction of latrines. 900 latrines are required and 649 have been built. The initial prevalence (2006) of 44% for S. mansoni and 4% for S. haematobium are now respectively 1.9% and 1.4% (2013). The program must be continuous as shown in the Assoni village: a prevalence study in children 0-5 years old, for which praziquantel is not recommended, reveals an infestation rate for S. mansoni of 78% in 2008 and of 47% in 2012. This age group is an important parasite reservoir and health education of parents is absolutely necessary. A permanent and effective center like Ninefescha hospital for distribution of praziquantel, sensitization meetings and latrines control is essential for the success of the program.


Bargues L.,Ecole du Val de Grace | Fall M.M.,Service de reanimation chirurgicale brules
Annals of Burns and Fire Disasters | Year: 2015

Disaster situations involving mass burn casualties can occur at any time after a fire, a terrorist attack, an industrial explosion or a transport accident. The various burn societies in the world published recommendations on disaster burn-care planning. French burn society (Société Française d’Étude et de Traitement des Brûlures-SFETB) proposes triage of burned victims according to Total Burn Surface Area (TBSA), inhalation injury and associated traumatic injuries. This plan seeks to classify victims and to refer each burned patient to a bed suited to its needs (burn centre, surgical or medical ICU, Emergency room, surgical ward and triage). Emergency Medical Services play a pivotal role in this organisation: first care, advanced medical post, medical coordination, triage and transportation, additional equipment supply in proximal hospital. Burn disaster plan should be adapted to local medical resources. © 2015, Annals of Burns and Fire Disasters. All rights reserved.


Swiech A.,Federation d'anesthesie | Ausset S.,Ecole du Val de Grace
Reanimation | Year: 2016

In France, labile blood products (LBP) are obtained from volunteer donors, donated as whole blood and/or through apheresis. Guidelines concerning their therapeutic use have been recently updated by ANSM and HAS (French Health Autorities). They define good practices and ensure the safety of both donors and recipients. The risk for transmissible disease is controlled through medical selection of donors, deleukocytationmandatory for all LBP, viral screening techniques and by viral attenuation for plasma. Transformations and/or qualifications can be applied to LBP to meet specific indications. Complications related to transfusion (immunological, allergic, infectious, overload) cannot be neglected and justify a reasoned prescription. The new technologies available are dominated by the use of lyophilized plasma in the emergency setting and also used for overseasmilitary operations. In case ofmassive bleeding, the earliest possible association of plasma and platelets to the emergency transfusion of packed red blood cells (PRBC) halves the mortality due to exsanguination. The transfusion of whole blood, controlled and regulated, already commonly used in thewar setting for logistic reasons, is now extrapolated to the civilian setting (during civil disasters equivalent to military situations). In the future may appear, among others, the expansion of virus-mitigation techniques to the PRBC and the opening of the lyophilized plasma market. © 2016, Société de réanimation de langue française (SRLF) and Springer-Verlag France.


Clinical procedure is not established according to fixed guidelines. The contribution of neuroscience, technical and social advances such as the modification of health care university curricula interact with our viewpoint on this clinical perspective. The example of the construction and the deconstruction of a post-traumatic stress disorder over time illustrates the obvious fact that we can study thanks to an anthropological perspective which, with the editions of the DSM and psychometric studies, bring into question the degree of scientism of clinical psychiatry. The concept of psychic trauma and psycho-traumatic syndrome is changing in society in the same way as during the evolution of a psycho-traumatized subject because a clinical entity questions the subjectivity of a subject in connection with the subjectivity of an era. If the traumatic repetition syndrome has always existed, its expression changes according to the social context and the psychic progression of the psycho-traumatized subject. In contrast, what appears unchanging at the clinical and psychotherapeutic level is the absence of a universal response to a psychic trauma. In this respect, the traumatic reaction becomes emancipated from the general paradigm of stress turning to the singular as a subjective implication. The unmasking of this subjectivity during psychotherapy will enable the traumatic consequences to be overcome by recovering the existence of a sense to the event. If the paradigm of stress was useful in establishing epidemiological studies in spite of being criticized, this theoretical orientation has overall failed to open up the way for treatment. However, as the clinical perspective is continually changing, recent neuro-imaging and neurogenetics research have once again shown the theoretical evolution according to apparently external determinants but which could also change the treatment of the psychotraumatized patient.

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