Sainte-Foy-lès-Lyon, France
Sainte-Foy-lès-Lyon, France

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Gaillard Y.P.,Laboratory of Analytical Toxicology | Cuquel A.-C.,Laboratory of Analytical Toxicology | Boucher A.,Center dEvaluation et dInformation sur la Pharmacodependance | Romeuf L.,Laboratory of Analytical Toxicology | And 3 more authors.
Journal of Forensic Sciences | Year: 2013

A 20-year-old man, a cocaine addict and regular ecstasy user, with a medical history of allergic asthma died after ingesting half a tablet earlier the same day. The white tablet, stamped with a "smiling sun" logo looked very much like an ecstasy tablet and was sold as such. He experienced a severe asthma attack just after ingesting the half tablet and it evolved over the next few hours into fatal cardiorespiratory arrest. Biological samples, taken after embalming, were analyzed by high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Analysis revealed meta-chlorophenylpiperazine (mCPP) in concentrations of 45.8 mg in a similar tablet obtained later from the drug dealer, 5.1 ng/mL in the bile, 0.3 ng/g in the liver, 15.0 ng/mL in the urine, and its absence in a hair sample (<0.02 ng/mg), which indicated he was not a regular user (whereas strong concentrations of MDMA and cocaine were found in the hair). Interrogated by the police after his arrest, the dealer said that he had sold the victim and for the very first time two tablets with the same "smiling sun" logo. The tablet used for analysis was from the same brand as the one ingested by the victim. The autopsy excluded other causes of death, while the histological analyses showed a large number of polynuclear eosinophils in the bronchial walls, confirming the asthmatic pathology. None of the other organs examined (larynx, liver, heart, adrenal glands, and kidneys) showed any distinctive signs, and in particular no inflammatory infiltrate. The death was the result of an asthma attack in an asthmatic person, violently decompensated following ingestion of approximately 20 mg of mCPP. © 2012 American Academy of Forensic Sciences.


Queyriaux B.,Institute Of Medicine Tropicale Du Service Of Sante Des Armees | Texier G.,Institute Of Medicine Tropicale Du Service Of Sante Des Armees | Ollivier L.,Institute Of Medicine Tropicale Du Service Of Sante Des Armees | Galoisy-Guibal L.,Hopital dInstruction des Armees Desgenettes | And 9 more authors.
Emerging Infectious Diseases | Year: 2011

We obtained health surveillance epidemiologic data on malaria among French military personnel deployed to French Guiana during 1998-2008. Incidence of Plasmodium vivax malaria increased and that of P. falciparum remained stable. This new epidemiologic situation has led to modification of malaria treatment for deployed military personnel.


Prat N.,Institute Of Recherche Biomedicale Des Armees Irba | Rongieras F.,Hopital dInstruction des Armees Desgenettes | de Freminville H.,University of Lyon | Magnan P.,French German Research Institute of Saint Louis | And 5 more authors.
Forensic Science International | Year: 2012

Background: Several models of ballistic blunt thoracic trauma are available, including human cadavers and large animals. Each model has advantages and disadvantages regarding anatomy and physiology, but they have not been compared with identical ballistic aggression. Methods: To compare thoracic wall behavior in 40-kg pigs and human cadavers, the thorax of 12 human cadavers and 19 anesthetized pigs were impacted with two different projectiles at different speeds. On the thoracic wall, the peak acceleration, peak velocity, maximal compression, viscous criterion, and injury criteria (e.g. abbreviated injury scale and number of rib fractures) were recorded. The correlations between these motion and injury parameters and the blunt criterion were compared between the two groups. The bone mineral density of each subject was also measured. Results: The peak acceleration, the peak velocity and the viscous criterion were significantly higher for the pigs. The AIS and the number of rib fractures were significantly higher for human cadavers. The bone mineral density was significantly higher for cadavers, but was, for the two groups, significantly lower than for 30-year-old human. Conclusion: The motion of the pig's thoracic wall is greater than that of the human cadaver, and the severity of the impact is always greater for human cadavers than for pigs. In addition, pig bone is more elastic and less brittle than older human cadaver bone. Due to the bone mineral density, the thoracic wall of human adults should be more rigid and more resistant than the thoracic wall of human cadavers or pigs. © 2012 Elsevier Ireland Ltd.


PubMed | Hopital dinstruction des armees Desgenettes, Hospices civils de Lyon, Service reanimation and Cellule dhygiene hospitaliere et lutte contre les infections nosocomiales
Type: Case Reports | Journal: Medecine et sante tropicales | Year: 2016

to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit.Careful review of the contacts and carriers files and outbreak management procedures.An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions.restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.


PubMed | Service de Pneumologie and Hopital dInstruction des Armees Desgenettes
Type: Journal Article | Journal: Military medicine | Year: 2014

Needle decompression of tension pneumothorax in soldiers of the French infantry has a risk for failure when the standard procedure that involves the insertion of a 14-gauge, 5-cm catheter into the 2nd intercostal space (ICS) is used. This study measured the chest wall thickness (CWT) to assess whether this approach is appropriate.CWT was measured by ultrasound in 122 French soldiers at the 2nd and 4th ICSs on both the right and left sides.CWT was measured at 4.19 cm ( 0.96 cm) at the 2nd ICS and 3.00 cm ( 0.91 cm) at the 4th ICS (p < 0.001). CWT was greater than 5 cm in 24.2% of cases at the 2nd ICS and 4.9% of cases at the 4th ICS (p < 0.001).This study suggests a high risk of failure when using the technique currently taught in the French army. A lateral approach into the 4th ICS could decrease this risk. The results of this study must be validated in patients presenting tension pneumothorax.


Turc J.,Hopital dinstruction des armees Desgenettes | Lamblin A.,Hopital dinstruction des armees Desgenettes | Klack F.,Hopital dinstruction des armees Desgenettes | Wey P.-F.,Hopital dinstruction des armees Desgenettes | Martinez J.-Y.,Hopital dinstruction des armees Desgenettes
Annales Francaises d'Anesthesie et de Reanimation | Year: 2012

Anaesthetic management of patients with pulmonary hypertension is challenging and alternatives to general anaesthesia are encouraged. We report anaesthetic management of two patients with pulmonary hypertension admitted for femoral neck fracture. In order to reduce the risk of right-sided heart failure and systemic hypotension, it was decided to operate the patients under continuous spinal anaesthesia. Anaesthesia was induced with excellent hemodynamic tolerance. Quality and extension of the block was correct and allowed surgery. No postoperative complication was observed. These cases suggest that continuous spinal anaesthesia may be considered for the management of patients with pulmonary hypertension undergoing femoral neck fracture surgery. © 2012 Société française d'anesthésie et de réanimation (Sfar).


Hlaihel C.,University of Lyon | Guilloton L.,Hopital dInstruction des Armees Desgenettes | Guyotat J.,University of Lyon | Streichenberger N.,University of Lyon | And 2 more authors.
Journal of Neuro-Oncology | Year: 2010

The aim of our study was to evaluate the role of proton magnetic resonance (MR) spectroscopy and MR perfusion in the follow-up of low-grade gliomas, since conventional MR imaging (MRI) is not reliable in detecting the passage from a low- to high-grade tumor. Twenty-one patients with a World Health Organisation (WHO) grade II glioma were followed up using proton MR spectroscopy, perfusion, and conventional MRIs. Follow-up MRIs had been performed at the third month of evolution and then twice a year, with an average of five MR studies per patient. Five out of the 21 patients had an anaplastic transformation. A choline to creatine ratio (choline/creatine ratio) above 2.4 is associated with an 83% risk of a malignant transformation in an average delay of 15.4 months. The choline/creatine ratio at this threshold was more efficient than perfusion MR in detecting the anaplastic transformation, with sensitivity of 80% and specificity of 94%. An increased choline/creatine ratio seemed to occur an average 15 months before the elevation of relative cerebral blood volume (rCBV). The mean annual growth of low-grade glioma was 3.65 mm. A growth rate higher than 3 mm per year was also correlated with greater risk of anaplastic transformation. Proton magnetic resonance spectroscopy should be recommended in the follow-up of low-grade gliomas since the choline/creatine ratio can predict anaplastic transformation before perfusion abnormalities, with high positive predictive value of 83%. © 2009 Springer Science+Business Media, LLC.


Cornut P.-L.,University of Lyon | Poli M.,University of Lyon | Feldman A.,University of Lyon | El Chehab H.,Hopital dinstruction des armees Desgenettes | And 3 more authors.
Journal Francais d'Ophtalmologie | Year: 2010

Purpose: To evaluate the efficacy and safety of intravitreal ranibizumab (Lucentis) in the first-line treatment of choroidal neovascularization (CNV) secondary to pathological myopia. Methods: Consecutive series of patients with primary subfoveal CNV secondary to pathological myopia treated with intravitreal ranibizumab 0.5 mg (0.05 ml) were included prospectively in this study. Best-corrected visual acuity, fundus examination, fluorescein angiography, optical coherence tomography, and the presence of metamorphopsia were assessed at baseline and then monthly. Indications for retreatment were persistent leakage from CNV shown on FA and/or evidence of CNV activity on OCT. Results: Eight eyes of seven patients were followed from November 2007 to April 2009. The mean age was 61 years. None of these eyes had been treated previously with photodynamic therapy or direct photocoagulation. The mean spherical equivalent refractive error was -10.75 (range: -7.75 to -15.75). Follow-up was 12 months or more for all patients except one (3 months). The mean number of intravitreal injections administered for each patient was 1.5 (range: 1-4). Six eyes received one ranibizumab injection, one eye received two, and one eye received four. Four eyes demonstrated a gain in visual acuity, three eyes stabilization, and one eye vision loss. No injection complications or drug-related side effects were noted during the follow-up period. Conclusions: In this small series of eyes with limited follow-up, intravitreal ranibizumab was a safe and effective treatment for CNV secondary to pathological myopia, resulting in functional and anatomic improvements. © 2010 Elsevier Masson SAS. All rights reserved.


PubMed | hopital dinstruction des armees Desgenettes and Service Of Pharmacie Hospitaliere
Type: Journal Article | Journal: Annales pharmaceutiques francaises | Year: 2016

Administration of parenteral iron is a mainstay of iron deficiency treatment. Evaluation and control of this element is an issue for healthcare facilities. Study of parenteral iron use is thus to be evaluated in its impact in terms of hospital economics.Parenteral iron administrations that took place on 2014in our healthcare facility were retrospectively identified by pharmacists. Following data were extracted from Pharma and Crossway softwares: indication, diagnostic coding and total dose of iron received. They were then compared to the summary of product characteristics.Of 198analyzed prescriptions, iron deficiency was known or suspected for 97% of patients. However, the total dose of iron administered was not in compliance for three quarters of prescriptions. Sixty-eight percent of patients appear under-dosed. Administrations traceability was found for two-thirds. Eighty-five hospital discharges did not have the right coding and 34stays were charged like an external act instead sessions. Financial loss for the hospital is estimated at 49,300euros.As part of improving practice, close pharmaceutical monitoring of parenteral iron prescribed dosing regimen is essential. Effective communication with the medical information department and regular awareness raising of prescribers should also allow to give more value to this act. Hospital economics is a real tool to aid decision-making.


PubMed | Hopital dinstruction des armees Desgenettes
Type: Journal Article | Journal: Medecine et sante tropicales | Year: 2013

Double hand amputation leads to complete loss of prehensive function and touch sense. Patients become totally dependent on others for survival. In developing countries, where sophisticated myoelectric prosthesis are not available, the Krukenberg procedure gives to these patients elementary self-sufficiency for daily-life. This procedure can be performed in low-resources setting and requires minimal rehabilitation. However, patient selection and preparation are critical because of an unattractive aesthetic aspect which limits this operation use in occidental countries.

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