Mouvement de libération des femmes de Genève 1971- 1980 Discours sur la contraception

Ce travail de maitrise a été pour moi l’occasion de pouvoir aborder la médecine différemment de ce que j’ai pu faire pendant mes six années d’études. En effet, la pratique médicale ne peut être comprise sans étudier la manière dont elle se construit et la société dans laquelle elle évolue. C’est pour cette raison que j’ai décidé de faire un travail en histoire de la médecine. Le sujet de la contraception m’a toujours intéressée. En effet, elle touche de nombreux domaines comme la médecine, la démographie et questionne les rapports au genre et à la sexualité. C’est aujourd’hui une pratique que l’on associe naturellement à la médecine alors que ce n’est que récemment que les médecins s’y sont intéressés1. Sensible aux questions touchant à la santé des femmes, à la médicalisation de leur vie et plus largement au féminisme, l’histoire de la contraception et plus précisément celle de la pilule contraceptive à travers les mouvements féministes, m’intéresse tout particulièrement. Les débats autour de la pilule contraceptive reviennent d’ailleurs souvent dans notre actualité et il me semblerait qu’aujourd’hui il y ait une certaine désaffection envers la pilule. C’est en tout cas l’impression que m’ont donnée les nombreux articles de journaux et reportages télévisés parlant des dangers de la pilule2, ainsi que mes nombreuses amies ayant renoncé à la pilule pour revenir à des méthodes de contraception plus naturelles. Mais cette désaffection est-elle nouvelle ? Comment la pilule contraceptive a-t-elle été accueillie dans la société suisse lors de sa mise sur le marché ? J’ai donc décidé d’aborder le sujet de l’arrivée de la pilule en Suisse romande et me suis particulièrement intéressée à la manière dont ce médicament est devenu un objet de lutte symbolique des mouvements féministes des années 1970. Ces féministes avaient fait de la lutte pour la démocratisation de la contraception un de leurs principaux combats. Mais qu’avaient-elles réellement énoncé sur la pilule contraceptive ? Au fur et à mesure de mes recherches sur les mouvements féministes suisses des années 70, j’ai découvert que l’un des mouvements qui avait le plus fait parler de lui à l’époque en Suisse romande était le MLF (Mouvement de Libération des Femmes) de Genève. Leur fonds d’archives à Genève va constituer le matériel de base de mon travail. L’objet du présent travail consistera en l’étude des discours, et l’analyse des arguments du MLF sur les bienfaits ou les méfaits de la pilule contraceptive. En particulier, j’exposerai comment, dans son discours, le MLF-Genève a mis en lien la pilule contraceptive avec les thèmes de la libération sexuelle, du pouvoir médical et du pouvoir politique

Aortic stent-grafting: successful introduction into the combined procedure for coronary artery bypass grafting and aortic aneurysm repair

Objectives: Coronary artery bypass grafting (CABG) and combined stent-grafting (SG) were evaluated to reduce morbidity and mortality of patients with descending or infrarenal aortic aneurysm. Methods: CABG and SG (thoracic n=6, infrarenal n=36) were performed during the same hospitalization in 42 patients (mean age of 73±14 years). In 29 patients (mean Euroscore: 9), SG was performed under local anesthesia 9±3 days after coronary surgery (simultaneous) and in 13 patients (mean Euroscore: 7) during the same anesthesia (synchronous). In the latter group, 11 out of 13 patients underwent off-pump CABG. All aneurysms were treated by implantation of commercially available self-expanding grafts. Results: CABG was successful in all, but one patient with left internal mammary artery hypoperfusion syndrome, requiring an additional distal saphenous graft to the left anterior descending coronary artery. SG was uneventful in 98% (41/42 patients). Postoperative computerized tomography showed incomplete sealing in seven patients (17%), but only the two attachment endoleaks had to be treated by one proximal and one distal SG extension. Overall hospital stay for the synchronous repair was 12.5±6 days and that of the simultaneous group 17.5±7 days. Thirty-day mortality was 5% (2/42) as one patient of the simultaneous group experienced a lethal cerebral embolism during SG and one patient of the synchronous group developed an untreatable infection. In the follow-up of 4 years, there were two vascular reinterventions but no additional procedure-related morbidity or mortality. Conclusions: This experience shows that combined CABG and SG of thoracic or infrarenal aortic aneurysm is a safe and less-invasive alternative to the open graft repair, especially in the older patients or patients with severe comorbiditie

Transmyocardial laser revascularisation in acutely ischaemic myocardium

Objective: Although recent experience suggests that transmyocardial laser revascularisation (TMLR) relieves angina, its mechanism of action remains undefined. We examined its functional effects and analysed its morphological features in an animal model of acute ischaemia. Methods: A total of 15 pigs were randomised to ligation of left marginal arteries (infarction group, n=5), to TMLR of the left lateral wall using a holmium:yttrium-aluminium garnet (Ho:YAG) laser (laser group, n=5), and to both (laser-infarction group, n=5). All the animals were sacrificed 1 month after the procedure. Haemodynamics and echocardiography with segmental wall motion score were carried out at both time intervals (scale 0-3: 0, normal; 1, hypokinesia; 2, akinesia; 3, dyskinesia). Histology of the involved area was analysed. Results: Laser group showed no change of the segmental wall motion score of the involved area 30 min after the laser channels were made (score: 0±0). Infarction and laser-infarction groups both showed a persistent and definitive increase of the segmental wall motion score (at 30 min: 1.6±0.3 and 2±0, respectively; at 1 month: 1.8±0.2 and 1.8±0.4, respectively). These increases were all statistically significant in comparison with baseline values (P<0.5), however comparison between infarction and laser-infarction groups showed no significant difference. On macroscopic examination of the endocardial surface, no channel was opened. On histology, there were signs of neovascularisation around the channels in the laser group, whereas in the laser-infarction group the channels were embedded in the infarction scar. Conclusions: In this acute pig model, TMLR did not provide improvement of contractility of the ischaemic myocardium. To the degree that the present study pertains to the clinical setting, the results suggest that mechanisms other than blood flow through the channels should be considered, such as a laser-induced triggering of neovascularisation or neural destructio

Intensivmedizinische Behandlung von Erwachsenen mit angeborenen Herzfehlern

Zusammenfassung: Dank Verbesserungen in der Herzchirurgie und der perioperativen Betreuung steigt die Anzahl der Erwachsenen mit einem angeborenen Herzfehler stetig. Die perioperative und intensivmedizinische Betreuung dieser Patienten stellt aufgrund der vielen verschiedenen Pathologien und chirurgischen Möglichkeiten sowie der komplexen Pathophysiologie eine Herausforderung dar. Viele Patienten entwickeln mit der Zeit Organdysfunktionen und viele von ihnen benötigen Folgeoperationen am Herzen sowie nichtkardiale Eingriffe im Erwachsenalter. Aufgrund der Komplexität sind diese Patienten in spezialisierten tertiären Krankenhäusern zu behandeln, die über ein disziplinenübergreifendes Fachwissen verfügen. Da dies in Notfällen nicht immer möglich sein wird, sind grundlegende Kenntnisse dieser Patientengruppe für in der Akutversorgung Tätige wichtig. In dieser Übersicht werden allgemeine Aspekte, wie pulmonale Hypertonie, Eisenmenger-Syndrom, Zyanose, Schwangerschaft und perioperative Betreuung, behandelt. Ein besonderes Augenmerk gilt dabei der intensivmedizinischen Versorgung von kritisch kranken Patienten mit angeborenen Herzfehler

Heart rate elevations during early sepsis predict death in fluid-resuscitated rats with fecal peritonitis

BACKGROUND: In sepsis, early outcome prediction would allow investigation of both adaptive mechanisms underlying survival and maladaptive mechanisms resulting in death. The aim of this study was to test whether early changes in heart rate monitored by telemetry could predict outcome in a long-term rat model of fecal peritonitis. METHODS: Male Wistar rats (n = 24) were instrumented with a central venous line for administration of fluids, antibiotics and analgesics. A telemetry transmitter continuously collected electrocardiogram signals. Sepsis was induced by intraperitoneal injection of fecal slurry, and the animals were observed for 48 h. Additional animals underwent arterial cannulation at baseline (n = 9), 4 h (n = 16), or 24 h (n = 6) for physiology and laboratory measurements. RESULTS: 48-h mortality was 33% (8/24), with all deaths occurring between 4 and 22 h. Septic animals were characterized by lethargy, fever, tachycardia, positive blood cultures, and elevated cytokine (IL-1, IL-6, TNF alpha) levels. An increase in heart rate ≥ 50 bpm during the first 4 h of sepsis predicted death with sensitivity and specificity of 88% (p = 0.001). CONCLUSIONS: In this long-term rat sepsis model, prognostication could be made early by telemetry-monitored changes in heart rate. This model enables the study of underlying mechanisms and the assessment of any differential effects of novel therapies in predicted survivors or non-survivors

European Association of Cardiothoracic Anesthesiology (EACTA) Cardiothoracic and Vascular Anesthesia Fellowship Curriculum: First Edition

This special article summarizes the design and certification process of the European Association of Cardiothoracic Anesthesiology (EACTA) Cardiothoracic and Vascular Anesthesia (CTVA) Fellowship Program. The CTVA fellowship training includes a two-year curriculum at an EACTA-accredited educational facility. Before fellows are accepted into the program, they must meet a number of requirements, including evidence of a valid license to practice medicine, a specialist degree examination in anesthesiology, and appropriate language skills as required in the host centers. The CVTA Fellowship Program has 2 sequential and complementary levels of training—both with a modular structure that allows for individual planning and also takes into account the differing national healthcare needs and requirements of the 36 countries represented in EACTA. The basic training period focuses on the anesthetic management of patients undergoing cardiac, thoracic, and vascular surgery and related procedures. The advanced training period is intended to deepen and to extend the clinical and nontechnical skills that fellows have acquired during the basic training. The goal of the EACTA fellowship is to produce highly trained and competent perioperative physicians who are able to care for patients undergoing cardiac, thoracic, and vascular anesthesia

Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Levosimendan was first approved for clinical use in 2000, when authorization was granted by Swedish regulatory authorities for the hemodynamic stabilization of patients with acutely decompensated chronic heart failure (HF). In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitization and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced HF, right ventricular failure, pulmonary hypertension, cardiac surgery, critical care, and emergency medicine. Levosimendan is currently in active clinical evaluation in the United States. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and noncardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute HF arena in recent times and charts a possible development trajectory for the next 20 years