HOpital dinstruction des armees Robert Picque

Toulouse, France

HOpital dinstruction des armees Robert Picque

Toulouse, France
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Objective: To determine whether, after knee ligamentoplasty by hamstring graft, servicemen recovered military aptitude and specific sports activity within 7 months postoperatively. Method: Results in a cohort of 20 patients were assessed by the isokinetic excentric IJ (30°/s)/concentric Q ratio (240°/s), COFRAS score and a questionnaire on resumption of sports activity. Results: The difference in ratio as compared to the healthy side did not exceed 15% in 85% of patients, and the COFRAS score was 28.1/30. Results were independent of age, gender, surgical technique and individual surgeon. Discussion: Recovery of open and closed kinetic chain stability enabled recovery of military aptitude. However, 75% of patients, reported apprehension as preventing or limiting return to previous personal sports activity. Level of evidence: Level 2. © 2013 Elsevier Masson SAS. All rights reserved.


PubMed | Hopital Central, Hopital de Bicetre, Groupe Hospitalier du Center Alsace, University of Paris 13 and 5 more.
Type: Journal Article | Journal: Anaesthesia, critical care & pain medicine | Year: 2015

Insertion of vascular access is a common procedure with potential for iatrogenic events, some of which can be serious. The spread of ultrasound scanners in operating rooms, intensive care units and emergency departments has made ultrasound-guided catheterisation possible. The first guidelines were published a decade ago but are not always followed in France. The French Society of Anaesthesia and Intensive Care has decided to adopt a position on this issue through its Guidelines Committee in order to propose a limited number of simple guidelines. The method used was the GRADE() method using the most recently published meta-analyses as the source of references. The level of evidence found ranged from low to high and all the positive aspects associated with ultrasound guidance, i.e. fewer traumatic complications at puncture, probably or definitely outweigh the potential adverse consequences regardless of whether an adult or child is involved and regardless of the site of insertion.


Delmas Y.,University of Bordeaux 1 | Vendrely B.,University of Bordeaux 1 | Clouzeau B.,University of Bordeaux 1 | Bachir H.,University of Bordeaux 1 | And 16 more authors.
Nephrology Dialysis Transplantation | Year: 2014

BackgroundAn outbreak of haemolytic uraemic syndrome (HUS) due to Shiga toxin-secreting Escherichia coli (STEC) O104:H4 from contaminated fenugreek sprouts occurred in June 2011 near Bordeaux, France. In the context of this outbreak, all patients were treated with the monoclonal anti-C5 antibody, eculizumab.MethodsThe diagnosis of HUS was made based on haemolytic anaemia, low platelet count and acute kidney injury. Data were obtained from initial gastrointestinal symptoms to the end of follow-up 10 weeks after the start of eculizumab.ResultsAmong 24 cases of STEC gastroenteritis, HUS developed in nine patients (eight adults and one child), 6 (median; range 3-12) days after digestive symptoms begun. The median (range) highest or lowest biological values were platelet count 26 (range 14-93) G/L; haemoglobin 6.6 (range 5-10.7) g/dL; LDH 1520 (range 510-2568) IU/L; creatinine 152 (range 48-797) μmol/L. All patients had extra-renal complications (liver 9, pancreas 5, brain 3 and heart 3). Two patients were dialysed, and one was ventilated. After failure of plasma exchange to increase platelets in the first three patients, eculizumab was administered in all nine patients, 0-4 days after HUS diagnosis (median 1 day). One patient with very severe neurological HUS received immunoadsorption. Outcome was favourable in all patients, with rapid normalization of haemoglobin, platelets, LDH levels, renal function and neurological improvement. There were no deaths and no serious adverse events related to eculizumab.ConclusionsEarly treatment of O104:H4 STEC-HUS by eculizumab was associated with a rapid and efficient recovery. Controlled prospective evaluation of eculizumab in STEC-HUS is warranted. © 2013 © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA.


Thomas G.,Service de Sante des Armees | Montean R.,Hopital dInstruction des Armees Robert Picque
Information Psychiatrique | Year: 2010

The question of temporality is ancient in psychopathology. Subjective time is a highly individual construction which intimately touches the individual during psychiatric disorders. Concept of alexithymia initially developed in the psychosomatic field contains peculiar modalities as regards its relationship with the world. In this article, we offer to explore the features of habitual relationships in the world of alexithymics from the point of view of temporality and to represent what in our sense can be subject to mobilization during relaxation psychotherapy monitoring.


Bailhache M.,Service de pediatrie medicale | Sarlangue J.,Service de pediatrie medicale | Castella C.,Service de pediatrie medicale | Richer O.,Service de pediatrie medicale | And 2 more authors.
Archives de Pediatrie | Year: 2011

Objective: We evaluated the severity of influenza A(H1N1)v clinical forms among infants less than 6 months of age. This population group was considered a high-risk group, so all people around them should be vaccinated first. Patients and methods: In south-western France in Aquitaine, we collected all infants less than 6 months of age during a period between the 6th September 2009 and the 6th January 2010 with influenza A(H1N1)v confirmed by PCR. For each of them, the risk factors, clinical presentation, hospitalization, and course of, the disease were identified. We compared two groups: children under 3 months and infants aged 3-6 months. Results: We identified 74 infants. The average age was 3 months. Sixteen infants had at least 1 risk factor: 9 respiratory diseases (12%), 8 born prematurely (but there was no preterm baby under 33 weeks); one infant presented a cardiac disease, and another 1 epilepsy. Five infants showed no fever, 73% had cough, and 24% had gastro-intestinal symptoms. Infants under 3 months of age presented less cough (P< 0.025) and fewer gastro-intestinal symptoms (P< 0.01) than older ones. Only 5 infants needed oxygen and 4 presented pneumonia. Forty-eight infants were hospitalized, including 1 in intensive care, with a median duration of 3 days. Forty-five percent spent 2 days or less in the hospital. Infants under 3 months of age were more often hospitalized (P< 0.001). Conclusions: Infants under 6 months of age did not present a severe form of influenza A(H1N1)v. Infants under 3 months of age were less symptomatic than older infants and were often hospitalized, but hospital stays were short with a good outcome. © 2011 Elsevier Masson SAS.


Van Cuyck H.,Hopital dInstruction des Armees Robert Picque | Farbos-Granger A.,Hopital dInstruction des Armees Robert Picque | Leroy P.,Hopital dInstruction des Armees Robert Picque | Yith V.,Institute Pasteur in Cambodia | And 4 more authors.
BMC Research Notes | Year: 2011

Background: Salmonella (S.) enterica is the main cause of salmonellosis in humans and animals. The epidemiology of this infection involves large geographical distances, and strains related to an episode of salmonellosis therefore need to be reliably discriminated. Due to the limitations of serotyping, molecular genotyping methods have been developed, including multiple loci variable number of tandem repeats (VNTR) analysis (MLVA). In our study, 11 variable number tandem-repeats markers were selected from the S. enterica Typhimurium LT2 genome to evaluate the genetic diversity of 206 S. enterica strains collected in Cambodia between 2001 and 2007. Findings. Thirty one serovars were identified from three sources: humans, animals and food. The markers were able to discriminate all strains from 2 to 17 alleles. Using the genotype phylogeny repartition, MLVA distinguished 107 genotypes clustered into two main groups: S. enterica Typhi and other serovars. Four serovars (Derby, Schwarzengrund, Stanley, and Weltevreden) were dispersed in 2 to 5 phylogenic branches. Allelic variations within S. enterica serovars was represented using the minimum spanning tree. For several genotypes, we identified clonal complexes within the serovars. This finding supports the notion of endemo-epidemic diffusion within animals, food, or humans. Furthermore, a clonal transmission from one source to another was reported. Four markers (STTR3, STTR5, STTR8, and Sal20) presented a high diversity index (DI > 0.80). Conclusions: In summary, MLVA can be used in the typing and genetic profiling of a large diversity of S. enterica serovars, as well as determining the epidemiological relationships of the strains with the geography of the area. © 2011 Kruy et al; licensee BioMed Central Ltd.


Kearns K.,HOpital dinstruction des armees Robert Picque | Tran Van D.,HOpital dinstruction des armees Robert Picque | Alberti N.,HOpital dinstruction des armees Robert Picque | Fontaine B.,HOpital dinstruction des armees Robert Picque | Fritsch N.,HOpital dinstruction des armees Robert Picque
Annales Francaises d'Anesthesie et de Reanimation | Year: 2013

Finding hepatic portal venous gas with pneumatosis intestinalis on computed tomography (CT) represents diagnostic and therapeutic challenge. The intestinal necrosis, particularly associated with acute mesenteric ischemia, is the very first hypothesis to assess, with the underlying question of an urgent surgery. However, knowing the non-surgical causes that have been identified in the last decade seems necessary to better assess the risk-benefit ratio of emergency surgery. Among these causes, we report the case of the acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, whose first line treatment is medical. © 2013 .


PubMed | Hopital dinstruction des armees Robert Picque
Type: Case Reports | Journal: Medecine et sante tropicales | Year: 2016

We report a case of pulmonary blastomycosis in a young man recently returned from a journey in Canada. He had acute pneumonia resistant to various antibiotics. Blastomycosis is an endemic mycosis in Canada and the United States, most frequently affecting the lungs, although extrapulmonary dissemination occurs in approximately one third of cases. Diagnosis is made by identification of Blastomyces dermatidis at direct examination or in culture. The lack of precise knowledge concerning the natural habitat of this microorganism is an obstacle to effective prevention.


He S.,Hopital d'instruction des armees Robert Picque | Cuguilliere A.,Hopital d'instruction des armees Robert Picque
Medecine et Sante Tropicales | Year: 2016

We report a case of pulmonary blastomycosis in a young man recently returned from a journey in Canada. He had acute pneumonia resistant to various antibiotics. Blastomycosis is an endemic mycosis in Canada and the United States, most frequently affecting the lungs, although extrapulmonary dissemination occurs in approximately one third of cases. Diagnosis is made by identification of Blastomyces dermatidis at direct examination or in culture. The lack of precise knowledge concerning the natural habitat of this microorganismis an obstacle to effective prevention. © 2016 JLE.


PubMed | Hopital dinstruction des Armees Robert Picque
Type: Journal Article | Journal: Medecine tropicale : revue du Corps de sante colonial | Year: 2010

Tuberculosis (TB) is still a major public health problem in the world despite the ambitious goals of the DOTS strategy, i.e., detection of 70% of new cases and successfully treatment of at least 85% of those cases. One of the main reasons for this relative failure is lack of a sensitive method for reliable diagnosis particularly in HIV-positive patients. Development of new diagnostic tools is a top priority in the WHOs Global plan to stop TB, 2006-2015. Numerous avenues of research have been proposed including development of immunological tests to detect antigens and antibodies, cutaneous tests, respiratory tests, improved solid or liquid culture techniques, alternatives to culture techniques, molecular biology techniques, etc. Some of these techniques will require long-term development and others will probably never be suitable for routine diagnosis. However a few innovations such as optimization of direct microscopic examination using new lower-priced fluorescence microscopes are ready for rapid deployment. Another promising area of research involves immunoenzymatic testing on urine samples. In any event clinical trials will be necessary to demonstrate the efficacy of these new diagnostic tools. These trials must be conducted and controlled under field conditions in the geographical zones where they will be used, i.e. in low-income countries with high incidences of TB.

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