La société de médecine, chirurgie et pharmacie de Toulouse au XIXeme sciècle

La Société de Médecine, Chirurgie et Pharmacie de Toulouse, fondée en 1801, a redonné un dynamisme scientifique à la ville et s'est assurée de l'amélioration constante des soins, en particulier par la création des consultations gratuites et d'un comité de vaccination. Grâce à ses différentes publications, la Société de Médecine a laissé une trace précieuse de ses travaux rapportant notamment des observations cliniques très détaillées et divers articles sur la vie médicale toulousaine. Nous pouvons reconnaître que les médecins toulousains du XIXeme siècle, ont été précurseurs dans le domaine de la vaccination et de l'hygiène publique, et ont intégré rapidement dans leur pratique les grands progrès médicaux qu'ont été l'anesthésie et l'antisepsie. De grands progrès ont également été réalisés sur le plan diagnostic grâce à une amélioration des connaissances en physiologie et anatomopathologie, l'autopsie étant pratiquée systématiquement lorsque l'étiologie du décès restait inconnue. Enfin la Société de Médecine, Chirurgie et Pharmacie a permis de rétablir l'enseignement en 1802, d'ériger l'Ecole de Médecine en 1806, et s'est beaucoup impliquée dans la lutte pour restaurer la Faculté de Médecine de Toulouse, inaugurée en 1891.TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L’enseignement de la médecine à Toulouse au xviiie et au xixe siècle

Au dix-huitième siècle, la faculté de médecine de Toulouse était la troisième de France par son importance, après Montpellier et Paris. Elle avait cinq chaires et une cinquantaine d’étudiants par année d’études, au moins dans la deuxième moitié du siècle. Pendant cette même période, s’est installée et développée une brillante école royale de chirurgie. La suppression de toutes les structures traditionnelles d’enseignement supérieur, par la Convention en 1793, décida les médecins et chirurgiens toulousains, désormais réunis, à recréer un enseignement médical, d’abord non officiel, puis officialisé par Napoléon en 1806. Ce ne fut qu’une école de médecine, mais la meilleure du pays, après les trois facultés recréées par l’Empire. En 1891, Toulouse récupéra enfin sa faculté de médecine.In the 18th century, the medical school in Toulouse was ranked third in France in importance, after Montpellier and Paris. The school had five chairs and around fifty students in each year of studies, at least in the second half of the century. During this same period, an excellent royal school of surgery was set up and developed. The elimination of all traditional structures of Higher Education, by the Convention of 1793, pushed Toulousain doctors and surgeons, now united, to create a sort of medical school which was at first unofficial, but was then recognised by Napoleon in 1806. It was merely a medical school but the best in the region after the three schools re-created by the Empire. In 1891, Toulouse finally recovered its medical school.En el siglo XVIII la Facultad de medicina de Toulouse era la tercera de Francia en importancia después de las de Montpellier y París. Tenía cinco cátedras y una cincuentena de estudiantes en cada curso, al menos en la segunda mitad de siglo. Durante el mismo período se creó y desarrolló una brillante escuela real de cirujía. La supresión de todas las estructuras tradicionales de enseñanza superior por la Convention en 1793 llevó a los médicos y cirujanos de Toulouse, ya reunidos, a volver a crear una enseñanza medical, primero no oficial, después oficializada por Napoleón en 1806. Fue sólo una escuela de medicina, pero la mejor del país, después de las tres facultades creadas de nuevo por el Imperio. Por fin Toulouse recuperó su Facultad de medicina en 1891

Comparison between Adult Patients with Sickle Cell Disease of Sub-Saharan African Origin Born in Metropolitan France and in Sub-Saharan Africa

Sickle cell disease (SCD) prevalence has increased rapidly in Europe as a result of an increase in the life expectancy of these patients and the arrival of SCD migrants from Africa. The aim of our study was to compare the phenotypes of adult patients born in Sub-Saharan Africa (SSA) who migrated to France with those of patients with the same origin who were born in France. This single-center observational study compared the demographic, clinical and biological characteristics of SCD adult patients of SSA origin who were born in France or SSA. Data were collected from computerized medical charts. Groups were compared using multivariate logistic regression with adjustment for age, gender and type of SCD. Of the 323 SCD patients followed in our center, 235 were enrolled, including 111 patients born in France and 124 patients born in SSA. SCD genotypes were balanced between groups. Patients born in Africa were older (median age 32.1 (24.4–39) vs. 25.6 (22.1–30.5) years, p < 0.001) and more often women (n = 75 (60.5%) vs. 48 (43.2%), p = 0.008). The median age at arrival in France was 18 years (13–23). The median height was lower among patients born in SSA (169 (163–175) vs. 174.5 cm (168–179), p < 0.001). Over their lifetimes, patients born in France had more acute chest syndromes (median number 2 (1–4) vs. 1 (0–3), p = 0.002), with the first episode occurring earlier (19 (11.6–22.3) vs. 24 (18.4–29.5) years, p < 0.007), and were admitted to intensive care units more often (53.3% vs. 34.9%, p = 0.006). This difference was more pronounced in the SS/Sβ0 population. Conversely, patients born in SSA had more skin ulcers (19.4% vs. 6.3%, p = 0.03). No significant differences were found in social and occupational insertion or other complications between the two groups. Patients born in SSA had a less severe disease phenotype regardless of their age than those born in France. This difference could be related to a survival bias occurring in Africa during childhood and migration to Europe that selected the least severe phenotypes

Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease

Preoperative transfusion (PT) reduces acute postoperative vaso-occlusive events (VOE) in sickle cell disease (SCD), but exposes patients to alloimmunization, encouraging a recent trend towards transfusion sparing. The aim of this study was to investigate the benefit–risk ratio of PT before cholecystectomy on the occurrence of postoperative VOE. Adult SCD patients who underwent cholecystectomy between 2008 and 2019 in our center were included. Patients’ characteristics, collected retrospectively, were compared according to PT. A total of 79 patients were included, 66% of whom received PT. Gallbladder histopathology found chronic cholecystitis (97%) and gallstones (66%). Transfused patients underwent more urgent surgeries and had experienced more painful vaso-occlusive crises (VOC) in the month before surgery (p = 0.05). Four (8.5%) post-transfusion alloimmunizations occurred, and two of them caused a delayed hemolytic transfusion reaction (DHTR) (4.3%). The occurrence of postoperative VOE was similar between the groups (19.2% vs. 29.6%, p = 0.45). Though not statistically significant, a history of hospitalized VOC within 6 months prior to surgery seemed to be associated to postoperative VOE among non-transfused patients (75% vs. 31.6%, p = 0.10). PT before cholecystectomy exposes to risks of alloimmunization and DHTR that could be avoided in some patients. Recent VOCs appear to be associated with a higher risk of postoperative VOE and prompt the preemptive transfusion of these patients

Primary Hyperparathyroidism in Sickle Cell Disease: An Unknown Complication of the Disease in Adulthood

International audiencePrimary hyperparathyroidism (pHPT) is the third most common endocrine disorder and usually affects patients between 60 and 70 years of age. To our knowledge, this condition has never been studied in young patients with sickle cell disease (SCD). Our objective was to describe the clinical and biological characteristics of pHPT in adult patients with SCD and its management. We conducted a retrospective study that included SCD patients who were diagnosed with pHPT in four SCD referral centers. pHPT was defined by the presence of elevated serum calcium levels with inappropriate normal or increased parathyroid hormone (PTH) serum levels or histopathological evidence of parathyroid adenoma or hyperplasia. Patients with severe renal impairment (GFR <30 mL/min) were excluded. Twenty-eight patients (18 women, 64%; 22 homozygous genotype, 79%) were included. The median age at pHPT diagnosis was 41 years (interquartile range –IQR- 31.5–49.5). The median serum calcium and PTH concentration were, respectively, 2.62 mmol/L (IQR 2.60–2.78) and 105 pg/mL (IQR 69–137). Bone mineral density (BMD) revealed very low BMD (≤−2.5 SD) in 44% of patients explored (vs. 12.5% among 32 SCD patients matched for SCD genotype, sex, age, and BMI, p = 0.03). Fourteen patients (50%) received surgical treatment, which was successful in all cases, but four of these patients (29%) presented with pHPT recurrence after a median time of 6.5 years. Three of these patients underwent a second cervical surgery that confirmed the presence of a new parathyroid adenoma. These results suggest that SCD is a condition associated with pHPT in young subjects. SCD patients with pHPT have a high risk of very low BMD. A diagnosis of pHPT should be suspected in the presence of mild hypercalcemia or low BMD in SCD patients. View Full-Tex

Acute chest syndrome in adult patients with sickle cell disease: The relationship with the time to onset after hospital admission

International audienceSummary Data on acute chest syndrome (ACS) in adult sickle cell disease patients are scarce. In this study, we describe 105 consecutive ACS episodes in 81 adult patients during a 32‐month period and compare the characteristics as a function of the time to onset after hospital admission for a vaso‐occlusive crisis (VOC), that is early‐onset episodes (time to onset ≤24 h, 42%) versus secondary episodes (>24 h, 58%; median [interquartile range] time to onset: 2 [2–3] days). The median age was 27 [22–34] years, 89% of the patients had an S/S or S/β 0 ‐thalassaemia genotype; 81% of the patients had a history of ACS (median: 3 [2–5] per patient), only 61% were taking a disease‐modifying treatment at the time of the ACS. Fever and chest pain were noted in respectively 54% and 73% of the episodes. Crackles (64%) and bronchial breathing (32%) were the main abnormal auscultatory findings. A positive microbiological test was found for 20% of episodes. Fifty percent of the episodes required a blood transfusion; ICU transfer and mortality rates were respectively 29% and 1%. Secondary and early‐onset forms of ACS did not differ significantly. Disease‐modifying treatments should be revaluated after each ACS episode because the recurrence rate is high

Impact of GH replacement therapy on sleep in adult patients with GH deficiency of pituitary origin.

We previously reported that adult patients with GH deficiency (GHD) due to a confirmed or likely pituitary defect, compared with healthy controls individually matched for age, gender, and BMI, have more slow-wave sleep (SWS) and higher delta activity (a marker of SWS intensity). Here, we examined the impact of recombinant human GH (rhGH) therapy, compared with placebo, on objective sleep quality in a subset of patients from the same cohort.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe