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Toulon, France

Gheorghiev C.,Service de psychiatrie | de Montleau F.,HIA Val de Grace | Clervoy P.,HIA Sainte Anne
Annales Medico-Psychologiques | Year: 2010

Objectives: This work consists in a study of the links between the concept of dangerousness and military environment so as to clarify predominant factors, which have an influence on the expression of a potential dangerousness in a hierarchical and well-organized setting. Methods: The concept of dangerousness refers to the uncertain eventuality of a threat, by implying potential realization of a danger, which can express himself according to multiple modalities, the common denominator of which articulates around a dimension of violence. The explicitation of the diverse notions, which are frequently associated with it in a partial semantic stepping, was a preliminary exercise necessary for the study of this complex phenomenon, by distinguishing what is of the register of the subject, its environment and the present situation. From these preliminary data, our study of the dangerousness was limited to that of a dangerousness applied to a given environment, the military environment, going from theoretical general points to a more restricted expression of the dangerousness. This transition finds its relevance in the absence of specificity a priori of the military population in comparison with the general population, where only the function here comes to particularize the subject. Peculiarities of expression of the dangerousness due to the dimension of constraints that the military environment implies, but also because of specificities organized around two essential coordinates, that liking the question of the weapons the availability of which appears to the foundation of the exercise of the function of serviceman and that bound to the question of the group within, which evolves the subject the interrelations of which modulate and sometimes condition the emergence of a potential dangerousness. Thus was described a particular dangerous collective phenomenon, the panic, whose emergence can deeply disorganize the group by representing a serious danger for its timelessness. The importance of the figure of the chief was emphasized by creating the unity of the group and giving sense to action; his lapse especially during time of war can be the source of important failures in the collective working leading to severe damages. Conclusions: Dangerousness seems to be connected with army for intrinsic reasons, as the use of weapons, which is correlative to its missions and the interrelations between a subject and a group whose disorganization can induce grave consequences. Military constraints due to its strict rules and discipline can participate to an appearance of dangerousness in particular during operational situations, whereas training and preparation enable to reduce the dangerousness, which is involved in these extreme conditions. © 2010 Elsevier Masson SAS.

Podoleanu C.,University of Medicine and Pharmacy of Targu Mures | DaCosta A.,CHU Nord | Defaye P.,Grenoble University Hospital Center | Taieb J.,Center hospitalier Aix en Provence | And 10 more authors.
Archives of Cardiovascular Diseases | Year: 2014

Background. - The role of implantable loop recorders (ILRs) in the evaluation strategy for recurrent syncope in France is limited by lack of knowledge of the cost.Aim. - To compare a conventional evaluation strategy for syncope with the early use of an ILR in low-risk patients, in terms of diagnostic yield, cost and impact on quality of life (QoL).Methods. - National prospective randomized open-label multicenter study of patients with a single syncope (if severe and recent) or at least two syncopes in the past year.Results. - Seventy-eight patients (32 men) were randomized to the ILR strategy (ILR group, n = 39) or the conventional evaluation strategy (CONV group, n = 39): mean age 66.2 ± 14.8 years; 4.3 ±6.4 previous syncopes. After 14 months of follow-up, a certain cause of syncope was established in 18 (46.2%) patients in the ILR group and two (5%) patients in the CONV group (P< 0.001). Advanced cardiological tests were performed less frequently in the ILR group than in the CONV group (0.03±0.2 vs. 0.2±0.5 tests per patient; P = 0.05). Patients in the ILR group were hospitalized for a non-significantly shorter period than patients in the CONV group (5.7± 3.2 vs. 8.0 ±1.4 days). There was no difference between the two groups in terms of QoL main composite score.Conclusion. - In patients with unexplained syncope, the early use of an ILR has a superior diagnostic yield compared with the conventional evaluation strategy, with lower healthcare-related costs. © 2014 Elsevier Masson SAS.

Barlesi F.,Aix - Marseille University | Chouaid C.,Center Hospitalier University Saint Antoine | Crequit J.,Center Hospitalier | Le Caer H.,Center Hospitalier | And 9 more authors.
Interactive Cardiovascular and Thoracic Surgery | Year: 2015

OBJECTIVES Adjuvant chemotherapy with vinorelbine plus cisplatin (VC) improves survival in resected non-small-cell lung cancer (NSCLC), but has negative impact on quality of life (QoL). In advanced NSCLC, gemcitabine plus cisplatin (GC) and docetaxel plus cisplatin (DC) exhibit comparable efficacy, with possibly superior QoL compared to VC. This trial investigated these regimens in the adjuvant setting. METHODS Patients with Stage IB to III NSCLC were eligible following standardized surgery. Overall, 136 patients were included, with 67 and 69 assigned to the GC and DC arms, respectively. Cisplatin (75 mg/m2, Day [D] 1) plus gemcitabine (1250 mg/m2, D1 and D8) or docetaxel (75 mg/m2 D1) were administered for three cycles. Primary end-point was QoL (EORTC QLQ-C30), with the study designed to detect a 10-point difference between arms. Overall survival, safety and cost were secondary end-points. RESULTS No between-group imbalance was observed in terms of patient characteristics. At inclusion, global health status (GHS) scores (/100) were 63.5 and 62.7 in GC and DC, respectively (P = 0.8), improving to 64.5 and 65.4 after 3 months (P = 0.8). No significant difference in functional or symptoms scores was observed between the arms except for alopecia. Grade 3/4 haematological and non-haematological toxicities were found in 33.8 and 21.7% (P = 0.11), and 33.8 and 26.1% (P = 0.33) of patients, in GC and DC, respectively. At 2 years, 92.9 and 89.8% of patients remained alive in GC and DC, respectively (P = 0.88). CONCLUSIONS DC and GC adjuvant chemotherapies for completely resected NSCLC were well tolerated and appear free of major QoL effects, and are therefore representing candidates for comparison with the standard VC regimen. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Soulard R.,HIA Sainte Anne | Souraud J.B.,HIA Sainte Anne | Souraud J.B.,British Petroleum | Landais C.,HIA Sainte Anne | And 2 more authors.
Journal of Cutaneous Pathology | Year: 2010

Q fever is a zoonotic infection caused by Coxiella burnetii. Two forms of the disease have been described: an acute form with pneumonia, hepatitis or a flu-like syndrome; and a chronic form in which endocarditis is the most frequent clinical expression. We report a 77 year old male with fever and an erythematous nodule on the right leg. Biopsy revealed a granulomatous lobular panniculitis with some granulomas rimmed by an eosinophilic material, giving a "doughnut" or "fibrin-ring" appearance. Q fever serological studies were positive. Cutaneous signs, among them panniculitis, are probably underestimated during the acute phase of the disease, and recognizing different granulomatous patterns may contribute to the diagnosis. Copyright © 2009 John Wiley & Sons A/S.

Bordes J.,HIA Sainte Anne | Cungi P.-J.,HIA Sainte Anne | Savoie P.-H.,Service durologie | Bonnet S.,Service de Chirurgie Viscerale | Kaiser E.,HIA Sainte Anne
Pan African Medical Journal | Year: 2015

Introduction: The assessment of anesthetic risks is an essential component of preoperative evaluation. In developing world, preanesthesia evaluation may be challenging because patient's medical history and records are scare, and language barrier limits physical examination. Our objective was to evaluate the impact of routine preoperative testing in a low-resources setting. Methods: Prospective observational study performed in a French forward surgical unit in Abidjan, Ivory Coast. 201 patients who were scheduled for non urgent surgery were screened with routine laboratory exams during preoperative evaluation. Changes in surgery were assessed (delayed or scheduled). Results: Abnormal hemoglobin findings were reported in 35% of patients, abnormal WBC count in 11,1% of patients, abnormal platelets in 15,3% of patients. Positive HIV results were found in 8,3% of cases. Routine tests represented 43,6% of changes causes. Conclusion: Our study showed that in a developing country, routine preoperative tests showed abnormal results up to 35% of cases, and represented 43,6% of delayed surgery causes. The rate of tests leading to management changes varied widely, from 0% to 8,3%. These results suggested that selected tests would be useful to diagnose diseases that required treatment before non urgent surgery. However, larger studies are needeed to evaluate the cost/benefit ratio and the clinical impact of such a strategy. © Julien Bordes et al.

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