Le surpoids chez les personnes en situation de handicap mental: le personnel infirmier a-t-il un rôle à jouer ? : travail de Bachelor

Notre travail de Bachelor porte sur le rôle que l’infirmier1 pourrait apporter dans la prévention du surpoids et de l’obésité chez une personne en situation d’handicap mental léger à modéré au sein d’une équipe pluridisciplinaire. Selon la Confédération suisse (2014), 41% de la population suisse de 15 ans et plus est en surpoids ou atteint d’obésité. Concernant le surpoids chez les personnes atteintes de déficience mentale, il est estimé à deux fois et demi plus élevé comparé à la population ordinaire (Unapei, 2013, p. 30). Lorsque le mot « obésité » est prononcé, deux corps professionnels sont de suite mis en avant : le diététicien et le physiothérapeute. Cependant, l’infirmier a un rôle primordial à jouer. Mais quel rôle a-t-il réellement ? De plus, a-t-il sa place dans les institutions spécialisées dans l’accompagnement des personnes en situation d’handicap mental? Qu’apporterait une vision infirmière dans cette prévention au sein de ces institutions ? Ce travail a pour but de comprendre la situation actuelle établie en lien avec le handicap et la prévention de l’obésité et de parvenir à identifier la place spécifique de l’infirmier dans une équipe composée, entre autre, d’éducateurs spécialisés et de diététiciens

Commerce and Justice: Ottoman and Venetian Courts in Istanbul during the Seventeenth Century

Commerce and Justice: Ottoman and Venetian Courts in Istanbul during the Seventeenth Century” analyzes legal disputes and economic transactions between Ottoman and Venetian merchants in Istanbul on a daily basis between 1600 and1620. At that time, the Venetians constituted the largest European community in the Ottoman capital, and they engaged intensively in trade ventures with Ottoman businessmen belonging to different religious and ethnic communities, including Muslim Turks, Sephardic Jews, and Orthodox Greeks. This dissertation asks how Ottomans and Venetians cooperated in commercial undertakings and solved controversies despite the absence of a system of inter-polity law and secular legal regimes in the early modern Mediterranean. Drawing from both Ottoman and Venetian primary sources, I address this question through a comparative study of three types of courts used by Ottoman and Venetian merchants in Istanbul for certifying their property rights and regulating their disputes: Islamic forums of justice headed by a Qadi (a Muslim judge), the Imperial Council (divan-ı hümayun) under the jurisdiction of the Grand Vizier, and the Venetian consular court. I argue that, despite differences in the normative systems, these institutions jointly promoted trade exchange by providing distinct but complementary legal and economic services to Ottoman and Venetian merchants that allowed commercial cooperation. Their first and foremost contribution was the certification of property rights across religious and political boundaries. I also maintain that the administration of justice for Venetian and Ottoman merchants was tightly entangled in the political and economic context of the seventeenth-century eastern Mediterranean and in the ebb and flow of Ottoman/Venetian relations. The political economy of the Republic of Venice and the Ottoman Empire affected the resolution of commercial and criminal controversies and the access of forums of justices for merchants belonging to different political and religious communities

Surgical Strategy in Midline Tumours of the Anterior Cranial Fossa

Midline tumors of the anterior cranial fossa (ACF) are mostly represented by olfactory groove menigiomas (OGM). There are many different approaches to this complex anatomical area but only a few that allow from the beginning dural implant removal: purely endoscopic transnasal (EA), transcranial/transfrontal sinus (TFA), and combined EA-TFA (CA) approach. Despite the improvement of EA, the optimal treatment strategy for the surgical treatment of OGM is still a matter of debate. The most advocate advantages of the EA are the absence of cerebral retraction and the possibility to resect the dural implant of the tumor, thus reducing its vascularization. On the other hand, it presents several limits: an important sinonasal morbidity, the loss of olfaction as default, increased risk of postoperative CSF leakage (5-10% in referral centers), especially in anteriorly located tumors. Moreover, the EA is contraindicated in case of lateral (above the orbital floor) or anterior extension (posterior wall of frontal sinus), cerebral parenchima involvment, or in case of major nerves or artery encasement. Consequently, only little tumors extended to the tuberculum sellae or planum sphenoidalis could be safely resected through a purely EA. The TFA is performed by a bicoronal incision, creating a craniotomy on the anterior wall of the frontal sinus and drilling the posterior wall of the frontal sinus. It gives direct access to the dural attachment of the tumor and avoids any cerebral retraction. In case of bulky or far posterior tumors, the interhemispheric route is usually very effective. The TFA permits to remove OGM of any dimension, to deal with nerves of vessel encasement, and to respect meningohypophyseal arteries. The incidence of postoperative CSF leakage is minimal since the closure with the galea is of the utmost effectiveness (0% in our experience). In case of sinonasal involvement, a CA is usually preferred

Variability of must acidity in self pollinated Chardonnay progeny

From a total of 2,200 seedlings, obtained by self-pollination of cv. Chardonnay clone SMA 130, 250 plants were chosen and grown in a hot microclimate area. During 1986-88, morphological traits of shoot tip, leaf and bunch, as well as juice quality (sugars, pH, titratable acidity, malic and tartaric acid) were evaluated. A wide variability of the acid characteristics was noticed in the offspring. There was a significant positive correlation between total acidity and bunch size. Tartaric acid concentration was highest in medium-size bunches. A highly significant negative correlation was found between tartaric acid concentration and berry volume. More acid juice was also obtained from grapevines with a narrower apex

Use of a neuro-evacuation device for the endoscopic removal of third ventricle colloid cysts

BackgroundColloid cysts are benign tumors usually located at the level of the foramen of Monro and account for approximately 1% of all intracranial tumors. Endoscopic surgical treatment represents the approach of choice for removal of these tumors and is usually preferred over transcortical or transcallosal microsurgical approaches. Our purpose is to demonstrate the feasibility of endoscopic removal of colloid cysts using a novel aspiration and fragmentation system, currently designed for evacuation of cerebral hematomas.MethodsWe performed an evaluation of the results obtained in patients with symptomatic colloid cysts of the third ventricle operated on using an endoscopic neuroevacuation system (Artemis Neuro Evacuation Device, Penumbra, Alameda, California, USA) between April 2020 and April 2022. Instrumentation and surgical technique are described in detail. All patients underwent postoperative MRI to assess the extent of cyst removal.ResultsFive patients were included in our study. The predominant symptom at onset was headache. No intraoperative complications related to the technology in use occurred. The surgical time for the cyst removal was significantly shorter than removal via a standard endoscopic technique (80 vs. 120 min). Removal was complete, both content and capsule of the cyst, in all patients. In all cases there was a complete regression of the previously complained symptoms.ConclusionThe Artemis Neuro Evacuation Device has proved to be effective and safe in removal of colloid cysts of the third ventricle and may be proposed as a possible alternative or as a complement of the standard instruments routinely used in neuroendoscopy

Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series

Small retrospective case series suggest that decompressive hemicraniectomy can be life saving in patients with cerebral venous thrombosis (CVT) and impending brain herniation. Prospective studies of consecutive cases are lacking. Thus, a single centre, prospective study was performed. In 2006 we adapted our protocol for CVT treatment to perform acute decompressive hemicraniectomy in patients with impending herniation, in whom the prognosis with conservative treatment was considered infaust. We included all consecutive patients with CVT between 2006 and 2010 who underwent hemicraniectomy. Outcome was assessed at 12 months with the modified Rankin Scale (mRS). Ten patients (8 women) with a median age of 41 years (range 26–52 years) were included. Before surgery 5 patients had GCS < 9, 9 patients had normal pupils, 1 patient had a unilaterally fixed and dilated pupil. All patients except one had space-occupying intracranial hemorrhagic infarcts. The median preoperative midline shift was 9 mm (range 3–14 mm). Unilateral hemicraniectomy was performed in 9 patients and bilateral hemicraniectomy in one. Two patients died from progressive cerebral edema and expansion of the hemorrhagic infarcts. Five patients recovered without disability at 12 months (mRS 0–1). Two patients had some residual handicap (one minor, mRS 2; one moderate, mRS 3). One patient was severely handicapped (mRS 5). Our prospective data show that decompressive hemicraniectomy in the most severe cases of cerebral venous thrombosis was probably life saving in 8/10 patients, with a good clinical outcome in six. In 2 patients death was caused by enlarging hemorrhagic infarcts

Intracranial Dural Arteriovenous Fistulas: The Sinus and Non-Sinus Concept

AbstractIntroduction: Dural arteriovenous fistulas (dAVFs) account for 10–15% of all intracranial arteriovenous lesions. Different classification strategies have been proposed in the course of the years. None of them seems to guide the treatment strategy. Objective: We expose the experience of the vascular group at Niguarda Hospital and we propose a very practical classification method based on the location of the shunt. We divide dAVF in sinus and non-sinus in order to simplify our daily practice, as this classification method is simply based on the involvement of the sinuses. Material and Methods: 477 intracranial dural arteriovenous fistulas have been treated. 376 underwent endovascular treatment and 101 underwent surgical treatment. Cavernous sinus DAVFs and Galen ampulla malformations have been excluded from this series as they represent a different pathology per se. 376 dAVFs treated by endovascular approach: 180 were sinus and 179 were non-sinus. 101 dAVFs treated with surgical approach: 15 were sinus and 86 were non-sinus. Discussion: Of the 477 intracranial dAVF the recorded mortality and severe disability was 3% and morbidity less than 4%. All patients underwent a postoperative DSA with nearly 100% of complete occlusion of the fistula. At a mean follow-up of 5 years in one case there was a non-sinus fistula recurrence, due to the presence of a partial clipping of "piè" of the vein. Conclusions: The sinus and non-sinus concept has guided our institution for years and has led to good clinical results. This paper intends to share this practical classification with the neurosurgical community