PANCREATITE AIGUE ET GROSSESSE

The association pancreatitis and pregnancy is rare, that occurs between 1/1000 and 1/12000 pregnancies. We will underline the influence of the acute pancreatitis on the pregnancy and the influence of this latest on the acute pancreatitis, through two cases. The biliary pathology was the etiology of the acute pancreatitis in these two patients; the first parturient was 32 year old, multipara in the second semester, that the diagnosis has been confirmed by the biology. The evolution was good under symptomatic treatment. Whereas the second parturient was 19 year old, primipara, in the 3th semester of pregnancy, that the pathologic past consists in angiocholitis and that the evolution was good under symptomatic treatment after the supervene of premature delivery. The acute pancreatitis supervenes generally in the young, multipara woman, during the last period of the pregnancy and the post-partum. The biliary etiology is the most frequent, favoured by the gravid modifications that cause the stasis and the development of calculi and vesicular mud. The clinical picture in pregnant woman is not specific, that may set the problem of the differential diagnosis, particularly with sympathic signs of the pregnancy. The amylasemia and the lipasemia confirm the diagnosis. The computerized tomography and especially IMR helps to diagnose of gravity. The treatment of the gestational acute pancreatitis is before all symptomatic. The maternal prognosis is generally good. The fetal complications are dominated by the risk of premature delivery, and acute foetal pain. The precocious diagnosis and the appropriate management of this pathology permit the improvement of the materno-fetal mortality.L’association pancréatite aigue et grossesse est rare, survenant entre 1/1000 et 1/12000 grossesses. Nous nous proposons de faire le point sur l’influence de la pancréatite aigue sur la grossesse et l’influence de cette dernière sur la pancréatite aigue, à travers deux observations. La pathologie biliaire était l’étiologie de la pancréatite aigue chez ces deux patientes, la première a été âgée de 32 ans, multipare, au deuxième trimestre, et dont le diagnostic a été confirmé par la biologie, l’évolution était bonne sous traitement symptomatique. Tandis que la deuxième a été âgée de 19 ans, primipare, au troisième trimestre, ayant comme antécédent  une angiocholite et dont l’évolution était bonne sous traitement symptomatique avec la survenue d’un accouchement prématuré. La pancréatite aigue survient généralement chez une jeune, multipare, à la deuxième ou la troisième partie de la grossesse et du post-partum. L’étiologie biliaire est la plus fréquente, favorisée par les modifications gravidiques entraînant la stase et la formation de calculs et de boue vésiculaire. Le tableau clinique est non spécifique posant le problème de diagnostic différentiel, surtout avec les signes sympathiques de la grossesse. L’amylasémie et la lipasémie confirment le diagnostic. La TDM et surtout l’IRM aident pour faire le diagnostic de gravité. Le traitement de la pancréatite aigue gestationnelle est avant tout symptomatique. Le pronostic maternel est généralement bon. Les complications fœtales sont dominées par le risque d’accouchement prématuré et la souffrance fœtale aigue. Le diagnostic précoce et la prise en charge adéquate de cette pathologie permettent l’amélioration de la morbidité et la mortalité materno-fœtale

HYSTERECTOMIE VAGINALE (A PROPOS DE 128 CAS)

Introduction : We conducted in our experience the indications of the vaginal hysterectomy and the factors considered to choose type of hysterectomy for benign uterus lesions and his real advantages compared to the others ways. Material and method: 230 hystérectomies carried out for benign indications on uterus not prolabé were re-examined respectively. The studied factors were the age of the patients, the nulliparity, the statute menopausic, the antecedents of laparotomy, the weight of the uterus, the nature of the benign lesions, the associated annexectomy and the complications Results: We reported a rate of 52,1% of the vaginal hystérectomies for uteruses weighing on average 310g (20-702g); 7,8% of the hystérectomies by coelioscopy with an average weight of 125g (40-215g) and 40% of the abdominal hystérectomies with an average weight of 1050g (55-2060g). Among the factors which we could show: the weight of the uterus, antecedents of laparotomy, nulliparity, practice of an associated annexectomy. Whereas the age of the patients, the statute menopausic, were not significantly different between the various ways initially. Conclusion: Vaginal hysterectomy is clearly the most preferred and practiced .Laparoscopy may be helpful for vaginal hysterectomy and laparotomy is exceptional.Introduction : Nous avons relevé  les indications de la voie vaginale, les différents facteurs intervenant dans le choix de la voie d’abord de l’hystérectomie et ses avantages réels par rapport aux autres voies d’abord. Matériel et méthodes : 230 hystérectomies réalisées pour des indications bénignes sur utérus non prolabé ont été revues respectivement. Les facteurs étudiés ont été l’âge des patientes, la nulliparité, le statut ménopausique, les antécédents de laparotomie, le poids de l’utérus, la nature des lésions bénignes, l’annexectomie associée et les complications. Résultat et analyse : Nous avons rapporté un taux de 52,1% des hystérectomies vaginales pour des utérus pesant en moyenne de 310g (20-702g) ; 7,8% des hystérectomies par coelioscopie avec un poids moyen de 125g (40-215g) et 40% des hystérectomies abdominales avec un poids moyen de 1050g (55-2060g). Parmi les facteurs que nous avons pu démontrer : le poids de l’utérus, les antécédents de laparotomie, la nulliparité, la pratique d’une annexectomie associée. Alors que l’âge des patientes, le statut ménopausique, n’ont pas été significativement différent entre les différentes voies d’abord. Conclusion : L’hystérectomie par voie vaginale est l’indication de choix  pour les lésions bénignes. La coelioscopie peut faciliter la pratique de l’hystérectomie vaginale et diminuer les laparotomies devenues exceptionnelles

School leadership and strategic planning

SIGLEAvailable from British Library Document Supply Centre-DSC:98/0433 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Off-label medicine use in children and adolescents: results of a population-based study in Germany

BACKGROUND: Population-based self-reported data on off-label medicine use independent from health care provisions are lacking. The purpose of this study is to investigate off-label medicine use in children and adolescents in Germany in a non-clinical setting and to identify prevalence, determinants and spectrum of off-label medicine use. METHODS: Data were obtained from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) conducted by the Robert Koch Institute (2003–2006). 17,450 randomly selected children aged 0–17 years took part in the drug interviews. Of those, 8,899 took at least one medicine during the 7 days preceding the interview. Off-label medicine use was defined as the discrepancy between actual use and the intended use described in the summary of product characteristics. Off-label medicine use was stratified into off-label indication, off-label age, off-label over-dosing, and off-label under-dosing. RESULTS: The prevalence rate of off-label medicine use among those who used medicines amount of is 40.2%. The prevalence rate is significantly higher in boys (41.4%), in children aged 3 to 6 years (48.7%), without migration background (40.9%), with high social status (42.5%), living in small (42.0%) and medium sized cities (41.6%), and with a poor parents rated health status (41.7%). 12,667 preparations (attributable in respect to off-label use) were taken by 8,899 children. 30% of the medicines have been used off-label. Off-label medicine use was highest in preparations of the ATC-class “C00 Cardiovascular System”. In all origins of medicine, all age groups and all ATC-classes under-dosing was the most frequent reason for off-label medicine use. CONCLUSIONS: There is a considerable level of self-reported off-label medicines use in the general paediatric population. Further investigations are needed to examine in how far off-label medicine use is based on lack of knowledge or on empiricism in paediatric pharmacotherapy. Attention also needs to be paid to under-dosing which potentially exposes drug users to risks of side effects without the benefit of a therapeutic effect. Clinical trials for licensing of paediatric medicines, education of health care professionals, but also of parents and carers are needed to ensure the rational use of medicines