L’injonction thérapeutique à l’égard des toxicomanes : comparaison des systèmes français et québécois

In Canada, the total amount of accusations, in compliance with the laws on drugs, show a slight but constant progression. More than half of the sentences for drug-linked offenses have lead to incarceration, a third of the people sentenced for a simple drug possession have been jailed. The relevance of these sentences, making the Canadian detention centres populated with more drug addicts than the rehabilitation centres, is questionable. In France, legislation is mostly based on the December 31st, 1970 law: drug use and trafficking are severely punished. However, for a first arrest, the prosecutor can enjoin the arrestee to treatment: this is what is called therapeutic injunction. Even though therapeutic injunction spares substance users from a jail term, some limitations are encountered this measure is selective, based on social and judicial criteria, making it more forgiving than the average characteristics of drug addicts, it is only accepted and applied by half of the subjects. A specific inquiry has been done in a department in the Paris region, where drug addiction activity is abundant, and suggested a preventive role for the injunction in cases of recidivism. Global appreciation of the therapeutic injunction remains nuanced in a context of new measures in drug addiction, but it translates into the increasing necessity to introduce professional networks between the judicial and sanitary systems, intended for a young population dealing with the modern difficulties of social adaptation and high risk behaviour

High-pressure intrapleural chemotherapy: feasibility in the pig model.

International audienceABSTRACT: BACKGROUND: The usual treatments for pleural malignancies are mostly palliative. In contrast, peritoneal malignancies are often treated with a curative intent by cytoreductive surgery and intraperitoneal chemotherapy. As pressure has been shown to increase antitumor efficacy, we applied the concept of high-pressure intracavitary chemotherapy to the pleural space in a swine model. METHODS: Cisplatin and gemcitabine were selected because of their antineoplasic efficacy in vitro in a wide spectrum of cancer cell lines. The pleural cavity of 21 pigs was filled with saline solution; haemodynamic and respiratory parameters were monitored. The pressure was increased to 15-25 cm H2O. This treatment was associated with pneumonectomy in 6 pigs. Five pigs were treated with chemotherapy under pressure. RESULTS: The combination of gemcitabine (100 mg/l) and cisplatin (30 mg/l) was highly cytotoxic in vitro. The maximum tolerated pressure was 20 cm H20, due to haemodynamic failure. Pneumonectomy was not tolerated, either before or after pleural infusion. Five pigs survived intrapleural chemotherapy associating gemcitabine and cisplatin with 20 cm H2O pressure for 60 min. CONCLUSIONS: High-pressure intrapleural chemotherapy is feasible in pigs. Further experiments will establish the pharmacokinetics and determine whether the benefit already shown in the peritoneum is also obtained in the pleura

Comparison of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a murin model of peritoneal carcinomatosis

<p>Abstract</p> <p>Background</p> <p>The best method to deliver intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis from ovarian cancer is not well defined. The aim of this study was to assess the ability of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a rat model of peritoneal carcinomatosis.</p> <p>Methods</p> <p>Four groups of 5 BDIX rats with ovarian peritoneal carcinomatosis underwent IPC with 30 mg/l of cisplatin according to the following conditions: normothermia at 37° for 1 or 2 hours, hyperthermia at 42°C for 1 hour or normothermia at 37°C for 2 hours with 2 mg/l adrenaline. Tissue platinum content was measured by atomic absorption spectroscopy. The effect of hyperthermia, adrenaline and the duration of exposure to the drug was measured <it>in vivo </it>(tissue concentration of platinum in tumor, abdominal and extra abdominal tissues) and <it>in vitro </it>(cytotoxicity on human ovarian cancer cells).</p> <p>Results</p> <p><it>In vitro</it>, hyperthermia and longer exposure enhanced the accumulation and the cytotoxic effect of cisplatin on cancer cells. <it>In vivo</it>, only the 2 hours treatment with adrenaline resulted in increased platinum concentrations. The rats treated with adrenaline showed significantly lower concentrations of cisplatin in extra peritoneal tissues than those treated with hyperthermia.</p> <p>Conclusion</p> <p>Adrenaline is more effective than hyperthermia in order to enhance the intratumoral concentration of cisplatin in rats with peritoneal carcinomatosis from ovarian origin. It may also decrease the systemic absorption of the drug.</p

Genetic relationships among yearling fertility, body composition and weight traits in tropically adapted composite cattle

Published Online: 6 April 2012 OnlinePublContext. Reproduction is an economically important trait in both males and females; however, the relationships between fertility and body composition traits are little researched, but essential to breeding programs, as they will help inform selection decisions and allow the greatest opportunity for genetic gain. Aims. Estimate genetic and phenotypic correlations between male and female yearling fertility traits and investigate their relationship with yearling body composition traits, which have an effect on the attainment of puberty. Methods. Genotype and phenotype data were obtained from a tropical composite commercial cattle population and imputed to 27 638 single nucleotide polymorphisms. A series of univariate and bivariate linear mixed models using a genomic relationship matrix were run to estimate genetic parameters, genetic and phenotypic correlations for a series of male and female fertility and body composition traits. These parameters were then compared to help understand the genetic relationships. Key results. Scrotal circumference was favourably genetically correlated with weight (0.34), fat traits (0.06–0.24), muscle (0.24) and heifer days to calving (−0.32). Heifer days to calving was favourably correlated with muscle (−0.18) but not fat traits (0.11 to 0.21). The genetic correlations between heifer days to calving and sperm morphology traits were generally unfavourable (−0.32 to 0.25). Sperm morphology traits were favourably genetically correlated with fat traits (−0.84 to 0.31) and muscle (−0.61 to 0.31) but not weight (−0.15 to 0.09). Conclusions and implications. Yearling sperm morphology traits were unfavourably correlated with heifer days to calving, indicating that they are not good candidates for indirect selection on improving female fertility in the herd. A different trend was found for yearling scrotal circumference and heifer days to calving, identifying it as a good candidate for indirect selection of heifer fertility as it is easy to measure and heritable. The genetic correlations estimated between composition traits with male and female fertility traits allow breeding programs to make an informed selection decision to optimise genetic gain across all traits.M.L. Facy, M.L. Hebart, H. Oakey, R.A. McEwin and W.S. Pitchfor

Total Gastrectomy for locally advanced Cancer: The total Laparoscopic Approach

Total gastrectomy is the treatment of choice for adenocarcinoma of the upper and middle third of the stomach resected with curative intent. The laparoscopic approach allows satisfactory exploration of the peritoneal cavity and optimizes staging in borderline T3 or T4 tumours in patients affected by locally advanced tumours or intraperitoneal carcinomatosis. Laparoscopy can eliminate unnecessary laparotomies in 10 % of patients affected by these conditions with formal contraindications for resection [1] . Complete resection of the stomach associated with D2 lymph node dissection is also performed using a currently well-established technique [2, 3] . The specificity of laparoscopic gastric resection for cancer is that the stomach and the greatomentum are withdrawn separately.Reconstruction of the digestive tract is more complex, and requires a variety of techniques (supra-umbilical mini-laparotomy, Orvil® technique, enlarging a port-site for passage of a circular stapler, mechanical side to side anastomosis, etc), but none ofthese has become the gold standard [4-7] . This explains the difficulties encountered in promoting the widespread use of minimally invasive resection in western countries. Scientific societies insist on the need for prospective studies to establish the place of laparoscopy for gastric cancer (prophylactic gastrectomy for CDH-1 related gastric cancer, &lt; T3 Tumours, palliative gastrectomy) [4] . Here, we present our technique for total resection of the stomach and D2 lymph node dissection, which allows the manualcreation of a feasible, safe, tension-free and effective esojejunal anastomosis. It can be performed by any surgeon familiar with laparoscopic surgery and the principles of oncologic resection. The cost is also relatively low because neither a circular staplernor other special equipment is required. Finally, the incision for extraction of the specimen can be placed in any area of the abdomen (usually through a supra-pubic incision in our practice).Keywords: Gastric cancer, laparoscopy, total gastrectomy, lymphadenectomy, Intracorporeal anastomosis.Total gastrectomy is the treatment of choice for adenocarcinoma of the upper and middle third of the stomach resected with curative intent. The laparoscopic approach allows satisfactory exploration of the peritoneal cavity and optimizes staging in borderline T3 or T4 tumours in patients affected by locally advanced tumours or intraperitoneal carcinomatosis. Laparoscopy can eliminate unnecessary laparotomies in 10 % of patients affected by these conditions with formal contraindications for resection [1] . Complete resection of the stomach associated with D2 lymph node dissection is also performed using a currently well-established technique [2, 3] . The specificity of laparoscopic gastric resection for cancer is that the stomach and the great omentum are withdrawn separately.Reconstruction of the digestive tract is more complex, and requires a variety of techniques (supra-umbilical mini-laparotomy, Orvil® technique, enlarging a port-site for passage of a circular stapler, mechanical side to side anastomosis, etc), but none of these has become the gold standard [4-7] . This explains the difficulties encountered in promoting the widespread use of minimally invasive resection in western countries. Scientific societies insist on the need for prospective studies to establish the place of laparoscopy for gastric cancer (prophylactic gastrectomy for CDH-1 related gastric cancer, &lt; T3 Tumours, palliative gastrectomy) [4] . Here, we present our technique for total resection of the stomach and D2 lymph node dissection, which allows the manual creation of a feasible, safe, tension-free and effective esojejunal anastomosis. It can be performed by any surgeon familiar with laparoscopic surgery and the principles of oncologic resection. The cost is also relatively low because neither a circular stapler nor other special equipment is required. Finally, the incision for extraction of the specimen can be placed in any area of the abdomen (usually through a supra-pubic incision in our practice).Keywords: Gastric cancer, laparoscopy, total gastrectomy, lymphadenectomy, Intracorporeal anastomosis

Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study

Background The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. Objectives The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). Methods In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. Results Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p &lt; 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors &lt; 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. Conclusions For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed

Perception of epidemic's related anxiety in the General French Population: a cross-sectional study in the Rhône-Alpes region

International audienceBackgroundTo efficiently plan appropriate public health interventions during possible epidemics, governments must take into consideration the following factors about the general population: their knowledge of epidemics, their fears of and psychological responses to them, their level of compliance with government measures and their communities' trusted sources of information. However, such surveys among the French general population are rare.MethodsA cross-sectional study was conducted in 2006 in a representative sample of 600 subjects living in the Rhône-Alpes region (south-east France) to investigate self-reported knowledge about infectious diseases and anxiety generated by epidemic risk with particular reference to avian influenza. Data on reactions to potentially new epidemics and the confidence level in various sources of information were also collected.ResultsRespondents were most knowledgeable about AIDS, followed by avian influenza. Overall, 75% of respondents had adequate knowledge of avian influenza. The percentage was even higher (88%) among inhabitants of the Ain district, where an avian influenza epidemic had previously been reported. However, 39% expressed anxiety about this disease. In total, 20% of respondents with knowledge about avian influenza stated that they had changed their behaviours during the epizooty. Epidemics were perceived as a real threat by 27% of respondents. In the event of a highly contagious outbreak, the majority of respondents said they would follow the advice given by authorities. The study population expressed a high level of confidence in physicians and scientists, but had strong reservations about politicians, deputies and the media.ConclusionsAlthough the survey was conducted only four months after the avian influenza outbreak, epidemics were not perceived as a major threat by the study population. The results showed that in the event of a highly infectious disease, the population would comply with advice given by public authorities