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The first home visit (VAD) by a nurse from the medical-psychological center (CMP) for a patient who has been out of psychiatric care for a very long time, or who has never benefited from it, is decisive for the follow-up and continuity of care. The attitude and posture of the caregiver are decisive. VAD is an intrusion into a place of life, intimacy and suffering. It upsets a person who has walled himself into a shell, a cocoon, from which the fear of coming out is often massive. Anguish prevents any mobilization towards care. It takes a great deal of skill to create a bond of trust to initiate the idea of care., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: ST-segment-elevation acute myocardial infarction (STEMI) is a therapeutic emergency. Early reperfusion is the key to successful reperfusion. Guidelines recommend organizing regional networks. In France, this starts with a call to a medical dispatch center, the SAMU-centre 15. The aim of this study was to evaluate regional STEMI management using data collected from 2002 to 2010., Methods: Observational, prospective, multicenter survey. STEMI patient with chest pain lasting for less than 24hours managed by 40 mobile emergency and resuscitation service (SMUR) and 8 emergency medical system (SAMU) from the Greater Paris Area (Île-de-France) were analyzed. Demographic data, cardiovascular risk factors, infarction location, decision of reperfusion and delays were collected. The rate of coronary reperfusion was chosen as the primary endpoint., Results: Eleven thousand five hundred and eighty-eight patients enrolled from 2002 to 2010 were analyzed. Median age was 59.9 (51.0 to 72.9) years; 9080 (78.5%) were men. The number of patients included decreased from 1376 in 2002 to 1119 in 2010. Reperfusion was achieved by fibrinolysis in 2644 (23%) cases and primary angioplasty in 7999 (69%) cases. The rate of decision of coronary reperfusion significantly increased from 86.7% in 2002 to 94.8% in 2010 (P<0.0001). Interaction between the increasing decision of reperfusion and all factors studied (demographics, cardiovascular risk factors, infarct location and delays) was significant only for family history of coronary artery disease (P=0.03). In-hospital mortality was 2.8% (321 cases)., Conclusion: The number of patients with STEMI managed by the SAMU declined slightly over the past decade. The rate of decision of reperfusion progressively increased up to 95%. Entrance into the network by the SAMU-centre 15 is a guarantee of a wide and early access to the coronary reperfusion., (Copyright © 2015. Published by Elsevier Masson SAS.)

Objective: To estimate the incidence of influenza infection with a rapid diagnostic test in patients hospitalized in an intensive care unit (ICU) during the epidemic periods of two consecutive winters (2005-2006)., Methods: This study tested nasal aspirate of all patients admitted to the ICU for acute respiratory failure during the influenza epidemic period with the QuickVue influenza rapid diagnostic test., Results: The study included 39 patients: 22 men and 17 women. Their mean age was 69.7+/-13 years, their mean SAPS II score 54+/-21, their mean length of stay 14.7+/-20 days, and 43.5% had been vaccinated against influenza. The mortality rate was 33.3% (n=13). Four patients (10.2%) had a positive QuickVue test and were considered to have influenza associated with their primary diagnosis: pneumococcal pneumonia, haemophilus pneumonia, acute bronchitis, and acute bronchitis with acute cardiogenic edema. These patients were older than those with a negative test (80+/-7 versus 68+/-13 years, p=0.02). Their SAPS II, length of stay and mortality rate did not differ statistically from those with negative results. Chronic heart failure (but not COPD or non-vaccination) was more frequent in these patients (p=0.01)., Discussion: Several published studies report a satisfactory specificity and sensitivity for QuickVue. With this test, we estimated the incidence of influenza in patients hospitalized in our ICU for acute respiratory failure during flu epidemics at around 10%, close to that reported in previous studies.

Aim: To evaluate the sensitivity, specificity, and predictive values of dipstick testing (DT) for detecting spontaneous bacterial peritonitis (SBP), defined by an ascites neutrophil polymorphonuclear cell count > or = 250/mm3, in patients with cirrhosis., Methods: The study includes all patients with cirrhosis and ascites admitted to our general hospital on the southern outskirts of the Paris metropolitan area (France) from June 2003 to May 2004 (n = 47:27 men and 20 women). Diagnostic abdominal paracentesis was performed on admission, and a Multistix SG (Bayer Pharma) reagent strip was immersed in one ascitic sample from each patient. Readings after 120 s were either negative (DT-) or positive (DT+, with 4 levels of positivity: trace, +, ++, or +++). In case of cytologically-proven SBP, patients were treated with cefotaxime, and subsequent paracentesis with DT and cytologic testing took place every 48 hours, until recovery., Results: Six of the 47 patients had proven SBP, all with clinical signs of SBP (fever and/or abdominal pain); five of these patients were DT+ and one was DT-. In the five patients initially DT+, the DT became negative at the same time as the cytologic criteria for SBP disappeared. Forty-one patients did not meet the cytologic criteria for SBP: 34 were DT- and 7 were DT+ (traces: 4, ++: 2, +++:1); two of these had clinical signs suggestive of SBP., Conclusion: Although the sensitivity (83%), specificity (83%) and negative predictive value (97%) of DTwere satisfactory, its positive predictive value (42%) was low. Dipstick testing of ascitic fluid is easy to perform and inexpensive and may be recommended for diagnosis and follow-up of SBP, especially in emergency settings.

The field of application for endoscopic hemoclips has been increasingly extended, especially thanks to improvements in clips and additional clinical indications. Hemoclips are used more frequently for upper gastrointestinal (GI) bleeding and sometimes after therapeutic endoscopy. We report the successful use of endoscopic hemoclips in the management of two cases of postoperative colonic haemorrhage.

The principal options for treatment of end-stage renal disease are hospital, out-center, self-or home hemodialysis or continuous ambulatory or automated peritoneal dialysis. Hemodialysis and peritoneal dialysis were long considered competitive methods, but they have become complementary and the same patient can use them successively at different life stages. The choice of technique usually depends on family, personal, social and work factors, rather than the medical situation. The healthcare team provides guidance to the patient in making this choice. The choice of treatment is optimal when the referral is early.

Background: Granular cell tumor of the cervical esophagus is a rare and benign tumor. We present a case of constricting granular cell tumor of the cervical esophagus and discuss esophageal reconstruction., Case Report: Constricting granular cell tumor of the cervical esophagus was diagnosed in a patient who experienced aphagia for two years. Endoscopy demonstrated complete stricture of the cervical esophagus and computed tomography and magnetic resonance imaging confirmed the presence of a tumor formation in the cervical esophagus. Total esophagectomy with preservation of the larynx was performed., Discussion: Surgical treatment raises the problem of esophageal reconstruction (gastric pull up, free flap reconstruction). We used the gastric pull up technique and fashioned a piriform sinus anastomosis. There was no postoperative complication and functional outcome was excellent., Conclusion: Computed tomography and magnetic resonance imaging provide essential data on the spread and location of granular cell tumor. Surgery provides excellent functional results.

Context: Despite the constant enrichment of the pharmacopoeia, the normalizing of blood pressure in hypertensive diabetic patients remains difficult., Objective: To assess the efficacy and acceptability of rilmenidine in first intention in hypertensive diabetics., Methods: In a population of 18 235 hypertensive patients, the sub-population of diabetic patients was followed-up in an open study over one year. These patients were initially treated with 1 mg/day of rilmenidine with the possibility of adapting the dose - increasing to 2 mg/d and association with a second or even third anti-hypertensor, left to the discretion of the physician - when the diastolic blood pressure remained strictly greater than 90 mmHg., Results: The complete blood pressure data over a period of 12 months were obtained in 2 311 patients out of 2 738 (84.4%). After 12 months' treatment, 75.9% of the 2 311 patients were normalized by the monotherapy with rilmenidine (diastolic blood pressure<90 mmHg according to the recommendations in force at the time of the study). The clinical acceptability was good and comparable to that obtained in the general population of 18 235 hypertensive patients. The biological parameters remained stable., Conclusion: This pharmaco-epidemiological assessment demonstrates, in conditions of current practice, the anti-hypertensive efficacy and acceptability of rilmenidine in hypertensive diabetics, therefore confirming its place in the therapeutic arsenal of these patients.