Prise en charge du pneumothorax spontané aux urgences du C.H.U d'Angers (évaluation des pratiques professionnelles de Juin 2009 à mai 2013)

INTRODUCTION : La conduite à tenir devant un pneumothorax spontané n est pas consensuelle. La décision de drainage thoracique ou d exsufflation dépend du lieu de prise en charge et du praticien. Le but de ce travail était d évaluer de façon rétrospective de juin 2009 à mai 2013, l adéquation au protocole (07/2008) de la prise en charge d un pneumothorax spontané primitif ou secondaire à une BPCO aux urgences d Angers. MATERIEL et METHODES : Les dossiers médicaux et les radiographies thoraciques ont été relus ; un questionnaire a été envoyé a tous les médecins ayant travaillé sur cette période. L adéquation au protocole du service était définie par plusieurs critères qui devaient tous être vérifiés selon le sous-type de pneumothorax : gravité, aspect radiologique, geste(s) technique(s) réalisé(s) en urgence et hospitalisation. RESULTATS : 161 pneumothorax spontanés primitifs ou secondaires à une BPCO ont été analysés. L adéquation globale de prise en charge était de 24,49%. Les taux de conformité les plus importants étaient ceux des pneumothorax graves et/ou mal tolérés (59,38%) ou des pneumothorax spontanés avec un petit décollement apical de moins de 2 cm (80%). L adéquation était de 8,33% pour les pneumothorax avec un décollement axillaire total et était nulle pour ceux avec un décollement apical de plus de 2 cm isolé. Une valeur intermédiaire a été calculée pour les pneumothorax secondaires non graves (44,44%). CONCLUSION : Des justifications humaines, matérielles ou logistiques expliquent une prise en charge globale du pneumothorax aux urgences d Angers qui n est pas conforme au protocole en vigueur au moment de l étude.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

The EXPRED study : where are we ?

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Development of Ovarian Tissue Autograft to Restore Ovarian Function: Protocol for a French Multicenter Cohort Study

International audienceDERR1-10.2196/12944.Sterility is a major late effect of radiotherapy and chemotherapy treatments. Iatrogenic sterility is often permanent and greatly impacts long-term quality of life. Ovarian tissue cryopreservation (OTC) performed before gonadotoxic treatments with subsequent autograft is a method of fertility preservation available for girls and women. Its application in prepubertal girls is of particular value as it is the only possible approach in this patient group. In addition, it does not require a delay in cancer therapy and no ovarian stimulation is needed.ClinicalTrials.gov NCT02846064; https://clinicaltrials.gov/ct2/show/NCT02846064

Does air pollution really impact the onset of spontaneous pneumothorax? A French case-crossover study

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Impact of a visual indicator on the noise level in an emergency medical dispatch centre - a pilot study

International audienceBackground: Noise levels are monitored in call centres. A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC). Methods: We conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on green if noise was below 65 dB(A), orange if noise ever exceeded 65 and red if it exceeded 75 dB(A). Results: In the presence of the visual noise indicator, the L Aeq was significantly lower than in the absence of visual noise indicator (a mean difference of − 4.19 dB; P < 10-3). It was higher than 55 dB(A) in 84.9 and 43.9% of the time in phases 1 and 2, respectively. Conclusions: The noise levels were frequently higher than the standards, and sometimes close to recommended limits, requiring preventive measures. The noise indicator had a positive effect on the ambient noise level. This work will allow the implementation of effective prevention solutions and, based on future assessments, could improve operators' well-being and better care for patient

Short term association between air pollution (PM10, NO2 and O3) and secondary spontaneous pneumothorax

International audienceSecondary spontaneous pneumothorax (SSP) occurs in the context of underlying pulmonary disease. Our objectives were to estimate the relationship between SSP and short term air pollution exposure with nitrogen dioxide (NO2), ozone (O3) and particulate matter with a diameter ≤ 10 μm (PM10). Patients with SSP were included between June 1, 2009 and May 31, 2013, in 14 Emergency Departments in France. In this case-crossover design study, PM10, NO2, and O3 data were collected hourly from monitoring stations. Quantitative values, fast increase in air pollutant concentration, and air quality threshold exceedance were retained. These assessments were calculated for each of the 4 days prior to the event (Lag 1-Lag 4) for all case and control period, and for the entire exposure period. A total of 135 patients with SSP were included, with a mean age of 55.56 (SD 18.54) years. For short term exposure of PM10, NO2 and O3, no differences were observed between case and control periods in terms of quantitative values of air pollutant exposure (P > 0.68), fast increase in concentration (P > 0.12) or air quality threshold exceedance (P > 0.68). An association between O3 exposures cannot be ruled out, especially when considering the Lag 2 prior to the event and in warm seasons

Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial

International audienceRationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate.Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax.Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18–50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan.Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026–0.200). The aspiration group experienced less pain overall (mean difference, −1.4; 95% CI, −1.89, −0.91), less pain limiting breathing (frequency difference, −0.18; 95% CI, −0.27, −0.09), and less kinking of the device (frequency difference, −0.05; 95% CI, −0.09, −0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, −0.07; 95% CI, −0.16, +0.02).Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events