Infections du site opératoire sur ablation de varices d’après une série continue de 408 interventions réalisées dans un centre hospitalier universitaire

But de l’étudeNotre objectif était de déterminer l’incidence des infections du site opératoire (ISO) consécutives à des interventions sur varices dans le service de chirurgie vasculaire d’un centre hospitalier universitaire. Patients et méthodes Une surveillance prospective des ISO a été mise en place pendant un an, avec un suivi postopératoire des patients de 30 jours. Le diagnostic d’ISO a été réalisé suivant les définitions des Centers for Disease Control (CDC, États-Unis). La saisie et l’analyse des données ont été réalisées à l’aide du logiciel Epi-Info des CDC. Résultats Les trois-quarts des 408 interventions incluses étaient caractérisées par un score de NNISS égal à 0. Une dépilation a été effectuée pour tous les patients, avec des modalités très variables et souvent non conformes (rasage mécanique dans 44,6 % des cas) aux recommandations nationales. L’incidence des ISO était de 1,2 % (intervalle de confiance à 95 % = [0,2–2,2]). Toutes les infections ont été diagnostiquées après retour au domicile. Quatre patients infectés sur cinq présentaient des problèmes de surpoids ou d’obésité et deux d’entre eux étaient diabétiques. L’âge moyen des patients était plus élevé chez les patients infectés (70,4 ans versus 52,0 ; p < 0,01). Les cinq ISO ont eu des conséquences (réhospitalisation et/ou reprise chirurgicale et/ou antibiothérapie). Conclusion D’après ces résultats, les ISO consécutives à des interventions sur varices sont rares et concernent principalement des patients à haut risque. Dans un but de prévention, il semble cependant nécessaire d’homogénéiser les pratiques de dépilation dans ce service

Venous thrombosis in immunocompetent patients with acute cytomegalovirus infection: a complication that may be underestimated

In the present study, we retrospectively studied clinical and laboratory findings associated with cytomegalovirus (CMV) infection in immunocompetent patients. We focused on severe CMV infection. Among 38 patients, five had a severe form of infection: one had meningitis, one had symptomatic thrombocytopenia and three had venous thromboses with pulmonary embolism, a rarely described complication. CMV-induced thrombosis has been reported in immunocompromised patients such as transplant recipients and patients with AIDS. Recent case reports have also described thrombotic phenomena in immunocompetent patients with CMV infection. Our study suggests that venous thrombosis during acute CMV infection is an underestimated complication

LUX -- A Laser-Plasma Driven Undulator Beamline

The LUX beamline is a novel type of laser-plasma accelerator. Building on the joint expertise of the University of Hamburg and DESY the beamline was carefully designed to combine state-of-the-art expertise in laser-plasma acceleration with the latest advances in accelerator technology and beam diagnostics. LUX introduces a paradigm change moving from single-shot demonstration experiments towards available, stable and controllable accelerator operation. Here, we discuss the general design concepts of LUX and present first critical milestones that have recently been achieved, including the generation of electron beams at the repetition rate of up to 5 Hz with energies above 600 MeV and the generation of spontaneous undulator radiation at a wavelength well below 9 nm.Comment: submitte

Chirp mitigation of plasma-accelerated beams using a modulated plasma density

Plasma-based accelerators offer the possibility to drive future compact light sources and high-energy physics applications. Achieving good beam quality, especially a small beam energy spread, is still one of the major challenges. For stable transport, the beam is located in the focusing region of the wakefield which covers only the slope of the accelerating field. This, however, imprints a longitudinal energy correlation (chirp) along the bunch. Here, we propose an alternating focusing scheme in the plasma to mitigate the development of this chirp and thus maintain a small energy spread

Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France

BackgroundBecause early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and determine prognostic factors. Patients and methods This study included all patients treated at Angers University Hospital between January 1995 and December 2005 for leptospirosis – both probable (cases combining epidemiologically suggestive features with compatible clinical, laboratory, and radiographic findings, with no other diagnosis envisioned) and confirmed (by finding microorganism on direct examination or culture of blood, urine or CSF, or by seroconversion or by a significant increase in the antibody titer between two samples). Severe leptospirosis was defined by hospitalization in the critical care department or need for renal dialysis. The statistical analysis used SPSS software version 12. Results Of 97 records reviewed, we retained 62 cases that met the criteria above, including 35 confirmed cases, 27 probable and 15 severe. The sex ratio was nine men for every woman. The patients\u27 mean age was 45 ± 18 years [12–77]. The principal clinical signs observed were: fever (n = 59) with shivering (n = 42), diffuse myalgia (n = 41), headaches (n = 38), jaundice (n = 24), conjunctival suffusion (n = 10), rash (n = 11), herpes eruption (n = 7), renal damage (n = 33) that was sometimes severe (>500 μmol/L) (n = 7), meningitis (n = 12), meningoencephalitis (n = 2), myocarditis or pericarditis (n = 6), and atypical radiographic lung disease (n = 16), sometimes with ARDS (n = 6). Blood tests showed thrombocytopenia (platelets < 140 G/L) in 65.5% of patients (n = 40). Logistic regression modeling showed that two criteria remained independently predictive of development toward severe leptospirosis: clinical jaundice (p = 0.005) and cardiac damage seen either clinically or on ECG (p < 0.02). These factors can be identified easily at the first clinical examination and during evolution, and should help to reduce mortality by allowing earlier management of patients with suspected leptospirosis

A novel experimental approach for studying spontaneous imbibition processes with alkaline solutions

Spontaneous imbibition processes can play an important role in oil production. It can be enhanced or influenced by wettability changes generated by properly designed chemicals or by the natural surfactants resulting from reactive crude oils in the presence of alkaline solutions. The reaction of basic salts with some components of oil can, indeed, lead to the formation of natural soaps that reduces the interfacial tension between oil and brine. The latter scenario is studied herein on samples and oil from the St Ulrich oil field in the Vienna basin. To that end, spontaneous imbibition experiments were performed with two brines differing by the absence or presence of alkali. We first present a general novel technique to monitor saturation changes on small rock samples for the purpose of assessing the efficiency of a given recovery process. Samples of only 15 mm in diameter and 20 mm in length and set at irreducible saturation were fully immersed in the solution of interest, and the evolution of the samples’ saturation with time was monitored thanks to a dedicated NMR technique involving the quantification of the sole oil phase present within the sample. A fully-3D imbibition configuration was adopted, involving counter-current flows through all faces of the sample. The experimental method is fast for two reasons: (i) the kinetics of capillary imbibition process is proportional to the square of sample size, i.e. very rapid if accurate measurements can be acquired on tiny samples, (ii) the present 3D situation also involves faster kinetics than the 1D configuration often used. The NMR technique was crucial to achieve such conditions that cannot be satisfied with conventional volumetric methods. The kinetics of oil desaturation during spontaneous imbibition is interpreted with the help of an analytical 3D diffusion model. For the alkaline solution, the diffusion coefficient is reduced by a factor of only two compared to the non-alkaline brine, although the interfacial tension between the oil and the imbibing solution is reduced by a factor of 10. Hence, a wettability change to a more water wet state has to be assumed when the alkaline solution replaces the non-alkaline solution in the imbibition process. However, no significant impact on the final saturation was observed

The FLASHForward Facility at DESY

The FLASHForward project at DESY is a pioneering plasma-wakefield acceleration experiment that aims to produce, in a few centimetres of ionised hydrogen, beams with energy of order GeV that are of quality sufficient to be used in a free-electron laser. The plasma wave will be driven by high-current density electron beams from the FLASH linear accelerator and will explore both external and internal witness-beam injection techniques. The plasma is created by ionising a gas in a gas cell with a multi-TW laser system, which can also be used to provide optical diagnostics of the plasma and electron beams due to the <30 fs synchronisation between the laser and the driving electron beam. The operation parameters of the experiment are discussed, as well as the scientific program.Comment: 19 pages, 9 figure

Réponse insuffisante à la stimulation en vue de FIV : maintenir la ponction ou choisir l&#039; insémination ?

In women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF), a poor ovarian response, defined as three of fewer mature follicles, can lead to cancellation of the cycle. However, in women with at least one patent tube and normal semen parameters, conversion to intrauterine insemination (IUI) is considered an option, offering reasonable pregnancy rates at a lower cost and without the complications associated with oocyte retrieval. Studies have shown that in cycles with only one mature follicle, IVF should be canceled. However, in cycles with 2 or 3 mature follicles, patients have the choice between IVF and conversion to IUI. Some studies have shown that IVF is superior to IUI in such cases, whereas other reports failed to find any difference. Most of these studies are retrospective and limited by the presence of several biases and low numbers of cycles, and to this date, there is no consensus on the best approach. We have thus designed a multicenter, randomized non-inferiority study, comparing live birth rates following conversion to IUI or IVF in patients with 2 or 3 mature follicles in COH cycles. Nine hundred and forty patients will be randomized on trigger day to either IVF or conversion to IUI. Our study will also include a medico-economic analysis

Epidémie d'hépatite A aiguë parmi des hommes ayant des rapports sexuels avec des hommes (HSH) Caractéristiques cliniques et épidémiologiques des cas diagnostiqués au CHU de Rouen

International audienc

Comparative effect of intraoperative propacetamol versus placebo on morphine consumption after elective reduction mammoplasty under remifentanil-based anesthesia: a randomized control trial [ISRCTN71723173]

BACKGROUND: Postoperative administration of paracetamol or its prodrug propacetamol has been shown to decrease pain with a morphine sparing effect. However, the effect of propacetamol administered intra-operatively on post-operative pain and early postoperative morphine consumption has not been clearly evaluated. In order to evaluate the effectiveness of analgesic protocols in the management of post-operative pain, a standardized anesthesia protocol without long-acting opioids is crucial. Thus, for ethical reasons, the surgical procedure under general anesthesia with remifentanil as the only intraoperative analgesic must be associated with a moderate predictable postoperative pain. METHODS: We were interested in determining the postoperative effect of propacetamol administered intraoperatively after intraoperative remifentanil. Thirty-six adult women undergoing mammoplasty with remifentanil-based anesthesia were randomly assigned to receive propacetamol 2 g or placebo one hour before the end of surgery. After remifentanil interruption and tracheal extubation in recovery room, pain was assessed and intravenous titrated morphine was given. The primary end-point was the cumulative dose of morphine administered in the recovery room. The secondary end-points were the pain score after tracheal extubation and one hour after, the delay for obtaining a Simplified Numerical Pain Scale (SNPS) less than 4, and the incidence of morphine side effects in the recovery room. For intergroup comparisons, categorical variables were compared using the chi-squared test and continuous variables were compared using the Student t test or Mann-Whitney U test, as appropriate. A p value less than 0.05 was considered as significant. RESULTS: In recovery room, morphine consumption was lower in the propacetamol group than in the placebo group (p = 0.01). Pain scores were similar in both groups after tracheal extubation and lower in the propacetamol group (p = 0.003) one hour after tracheal extubation. The time to reach a SNPS < 4 was significantly shorter in the propacetamol group (p = 0.02). The incidence of morphine related side effects did not differ between the two groups. CONCLUSIONS: Intraoperative propacetamol administration with remifentanil based-anesthesia improved significantly early postoperative pain by sparing morphine and shortening the delay to achieve pain relief