Ocular sonography in patients with raised intracranial pressure: the papilloedema revisited

Invasive devices are recommended for the early detection of raised intracranial pressure (ICP) after severe traumatic brain injury. Owing to contraindication or local issues, however, invasive ICP monitoring is not always possible. Moreover, a significant proportion of moderate traumatic brain injury patients (managed without invasive ICP) will develop raised ICP. Reliable noninvasive ICP techniques are therefore needed. Soldatos and colleagues report the usefulness of ocular sonography in the diagnosis of raised ICP. Focusing on cerebrospinal fluid accumulation around the retrobulbar optic nerve, they show interesting results for the optic nerve sheath diameter in the diagnosis of raised ICP. If confirmed by further studies, and despite important limitations related to sonography, this technique could serve as a screening test in patients at risk for raised ICP, when invasive monitoring is not possible or is not clearly recommended

Effects of single-dose injectable paracetamolversus propacetamol in pain management after minor gynecologic surgery: A multicenter, randomized, double-blind, active-controlled, two-parallel-group study

AbstractBackground:Intravenous administration is the route of choice for drug therapy in the immediate postoperative period. Propacetamol (ProAPAP), an injectable prodrug of paracetamol requiring reconstitution, has demonstrated efficacy in managing acute pain and fever. However, it has been associated with pain at the injection site. A stable, ready-to-use formulation of paracetamol solution infused intravenously (IV-APAP) has been developed and might be associated with less pain at the injection site compared with ProAPARObjective:The objective of this study was to assess the tolerability and efficacy of a single dose of IV APAP 1 g compared with those of a single dose of ProAPAP 2 g in patients with moderate to severe pain after minor gynecologic surgery.Methods:This single-dose, randomized, double-blind, active-controlled,2-parallel-group study was conducted at 23 hospitals and outpatient clinics in France. After minor gynecologic surgery, patients reporting moderate to severe pain were randomized to receive a single 15-minute infusion of IV-APAP 1 g or ProAPAP 2 g (bioeyuivalent doses). Tolerability was monitored using local and systemic adverse event (AE) reporting, clinical examination including vital sign measurement, and patients' ratings of acceptability of the infusion. Efficacy end points included pain intensity at 0, 1, 2, 4, and 6 hours; median time to rescue medication (defined as the time at which 50% of patients requested rescue medication); and percentage of patients requesting rescue medication. Patients' satisfaction with the study drugs was assessed using patient's global evaluation (PGE) and the percentage of patients willing to receive the treatment again.Results:Of the 163 women who were randomized, 161 received the studymedication. The IV-APAP group comprised 80 patients (mean [SD] age, 38.3 [12.8] years [range, 18.0-69.0 years]; mean [SD] weight, 61.1 [11.0] kg [range, 49.0–90.0 kg]), and the ProAPAP group comprised 81 patients (mean [SD] age, 33.9 [12.0] years [range, 18.0–67.0 years]; mean [SD] weight, 61.6 [10.2] kg [range, 42.0–95.5 kg]); the difference in mean age between the 2 groups was statistically significant (P < 0.05). The incidence of local treatment-emergent AEs (TEAEs) was significantly lower in the IV-APAP group compared with that in the ProAPAP group (7.5% vs 38.3%; P < 0.001). No between-group differences in the incidence of systemic TEAEs was found. All patients in the IV-APAP group found the infusion tolerable, compared with 95% of patients in the ProAPAP group. The median time to rescue medication was not evaluated because <50% of the patients in each group requested it. No significant differences in mean pain intensity score or percentage of patients requesting rescue medication were found between the 2 groups at any time point. The percentages of patients in the IV-APAP and ProAPAP groups who rated the study medication as good or excellent on the PGE (83.6% vs 75.6%; P < 0.05) and who were willing to receive the same treatment again (96.0% vs 81.0%; P = 0.005) were significantly higher with IV-APAP compared with ProAPAPConclusion:In these patients with moderate to severe pain after minor gynecologic surgery, a single dose of IV-APAP was associated with better local tolerability, similar analgesic efficacy, and greater patient satisfaction compared with a single bioequivalent dose of ProAPAP

An international survey of adherence to Surviving Sepsis Campaign Guidelines 2016 regarding fluid resuscitation and vasopressors in the initial management of septic shock

BACKGROUND: Our survey aimed to evaluate adherence to Surviving Sepsis Campaign (SSC) Guidelines 2016 among intensive care practitioners and to identify issues that remain controversial or lack clarity. METHODS: Members of the European Society of Intensive Care Medicine (ESICM) were surveyed using an anonymous web-based survey written by an international group of experts. The primary outcome measure was the rate of adherence to specific recommendations. Secondary outcomes were to describe areas of controversy and lack of data and to associate specific practices with clinician characteristics. RESULTS: Overall 820 questionnaires were completed. The SCC recommendations 2016 most adhered to were the choice of norepinephrine as first-line vasoactive drug (96.5%), vasopressor prescription based on therapeutic goal rather than dose (83.4%), targeting a specific mean arterial blood pressure during vasopressor use (77.9%), monitoring of blood pressure invasively (62.8%) and adding vasopressin or epinephrine as a second vasoactive agent (83.4%). We identified an internal conflict with regards to parallel versus sequential administration of fluids and vasoactive drugs and regional differences in practice that may be related to drug availabilities. CONCLUSION: The use of vasopressors and fluid use in septic shock is largely compliant with current guidelines but several controversies should be addressed in future guideline iterations

Using Prior Information from the Medical Literature in GWAS of Oral Cancer Identifies Novel Susceptibility Variant on Chromosome 4 - the AdAPT Method

Background: Genome-wide association studies (GWAS) require large sample sizes to obtain adequate statistical power, but it may be possible to increase the power by incorporating complementary data. In this study we investigated the feasibility of automatically retrieving information from the medical literature and leveraging this information in GWAS. Methods: We developed a method that searches through PubMed abstracts for pre-assigned keywords and key concepts, and uses this information to assign prior probabilities of association for each single nucleotide polymorphism (SNP) with the phenotype of interest - the Adjusting Association Priors with Text (AdAPT) method. Association results from a GWAS can subsequently be ranked in the context of these priors using the Bayes False Discovery Probability (BFDP) framework. We initially tested AdAPT by comparing rankings of known susceptibility alleles in a previous lung cancer GWAS, and subsequently applied it in a two-phase GWAS of oral cancer. Results: Known lung cancer susceptibility SNPs were consistently ranked higher by AdAPT BFDPs than by p-values. In the oral cancer GWAS, we sought to replicate the top five SNPs as ranked by AdAPT BFDPs, of which rs991316, located in the ADH gene region of 4q23, displayed a statistically significant association with oral cancer risk in the replication phase (per-rare-allele log additive p-value [p(trend)] = 2.5 x 10(-3)). The combined OR for having one additional rare allele was 0.83 (95% CI: 0.76-0.90), and this association was independent of previously identified susceptibility SNPs that are associated with overall UADT cancer in this gene region. We also investigated if rs991316 was associated with other cancers of the upper aerodigestive tract (UADT), but no additional association signal was found. Conclusion: This study highlights the potential utility of systematically incorporating prior knowledge from the medical literature in genome-wide analyses using the AdAPT methodology. AdAPT is available online (url: http://services.gate.ac.uk/lld/gwas/service/config)

A Sex-Specific Association between a 15q25 Variant and Upper Aerodigestive Tract Cancers

Sequence variants located at 15q25 have been associated with lung cancer and propensity to smoke. We recently reported an association between rs16969968 and risk of upper aerodigestive tract (UADT) cancers (oral cavity, oropharynx, hypopharynx, larynx and esophagus) in women (odds ratio (OR) =1.24, P=0.003) with little effect in men (OR=1.04, P=0.35)

Réhabilitation précoce après césarienne programmée : enquête de pratique auprès des maternités des régions Provence-Alpes-Côte d'Azur et Ile de France

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Evaluation des pratiques anesthésiques pour interruption médicale de grossesse tardive

L amélioration des techniques de dépistage prénatal a conduit à une augmentation du nombre d interruptions médicales de grossesse (IMG) en France ( 6000/an). L objectif de cette étude était de connaître les pratiques anesthésiques habituelles pour IMG après 14 semaines d aménorrhée. L étude a consisté en une enquête de pratiques auprès des équipes anesthésiques des maternités françaises attachées à un centre pluridisciplinaire de diagnostic prénatal (CPDPN). Ces pratiques ont été ensuite comparées aux pratiques des maternités de Paris et de ses départements limitrophes situées dans des établissements sans CPDPN. Dans les maternités attachées à un CPDPN, les anesthésistes participent au staff de diagnostic prénatal dans 36 % des centres et sont consultés en cas d indication maternelle dans 69 % des centres. Une analgésie périmédullaire est pratiquée chez plus de 90 % des patientes. La péridurale est posée après le foeticide dans 22 % des centres et après la mise en route du travail en l absence de foeticide dans 38 % des centres. Une sédation ou une anesthésie générale pour l expulsion est systématique ou à la demande de la patiente dans 2 % et 60 % des centres respectivement. Il existe peu de différences entre les maternités attachées à un CPDPN et celles qui ne le sont pas.En conclusion, la participation des anesthésistes à la décision d IMG mérite de se développer. L analgésie périmédullaire est la pratique habituelle et utilise des protocoles similaires à ceux utilisés pour l accouchement normal. La péridurale est parfois posée trop tardivement par rapport au déclenchement du travail ou au geste foeticide. La sédation ou anesthésie générale au moment de l expulsion semble répandue et pourrait favoriser un deuil périnatal pathologique.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Myasthénie, grossesse et accouchement (à propos de 10 cas)

L'objectif est d'étudier les interférences réciproques entre grossesse et myasthénie et décrire la prise en charge anesthésique et obstetricale pendant le travail et le post-partum. Le type d'étude est une enquête rétrospective. La méthodologie consiste à étudier des dossiers des 10 patients myasthéniques suivies entre octobre 1994 et mai 2002. Les résultats indiquent qu'aucune fausse-couche n'est survenue et que toutes les grossesses ont été menée à terme. Toutes les patientes suivaient un traitement de fond par anticholinestérastiques qui a été maintenu. Sept poussées ont été dépistées chez 6 patients et enrayées par une majoration des traitements (n=5), une par plasmaphérèse (n=1) et par immunoglobulines (n=1). Toutes les patientes ont eu une consultation pré-anesthésique autour de la 33ème SA. Une analgésie locorégionale précocement installée utilisant des concentrations faibles d'anesthésique local (péridurale, n= 7; rachianalgésie-péridurale, n= 2) s'est déroulée sans incident ni bloc moteur notable...PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Utilisation d'une base de données pour le recueil des incidents per et post opératoires (étude de l'incidence et des facteurs de risque d'hypotension artérielle)

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

EVALUATION DE DEUX PROTOCOLES D'ANALGESIE PERIDURALE DANS LE CAS DES UTERUS MONOCICATRICIELS

PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF