Biomedical subjects
Publications and source records attributed to J-L Bernard.
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Aneurysms of pancreaticoduodenal arteries represent only 2% of all aneurysms of digestive arteries. Occurrence of these aneurysms are favoured by stenosis or occlusion of the celiac axis. Aneurysm rupture is frequent and carries a mortality rate of 20%. Computed tomography with intravenous contrast and selective coeliomesenteric arteriography can make the diagnosis of this disease which can be treated by either surgery or embolotherapy. We report the case of a patient with a ruptured aneurysm of the pancreaticoduodenal arcades mimicking a perforated duodenal ulcer, and successfully treated by surgical ligation.
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OBJECTIVE: To describe how pediatric residents involve children during medical decision-making and evaluate the relationship between practice patterns and residents characteristics. POPULATION AND METHODS: We conducted a prospective multicenter anonymous written survey. Self-reported involvement of children by 45 French pediatric residents in practice pattern was collected and analysed. RESULTS: Most residents reported they informed patients in more than 50% of the cases (82%). Only a minority of the residents asked for consent, respected children refusal or presented other choices to the treatment. The main reasons that explain the lack of partnership are children incompetence and the medical situation. No statistically significant relationship between practice patterns and residents characteristics was found. CONCLUSIONS: Partnership with children varies across residents and according to the level of involvement considered. No statistical differences were obtained to explain variations between residents' attitude toward involvement of children. Nevertheless medical education in ethics or decision-making could increase partnership with children.
INTRODUCTION: Hafnia alvei is a commensal organism of the digestive tract. It is best known as an agent of pediatric gastro-enteritis. In adults, this organism may exceptionally be responsible for extra-intestinal infections. In such cases, infections occur mainly in unusually susceptible patients, due to an underlying condition. CASE REPORT: A 69 year-old man who had recently undergone surgery for a gastric stromal tumor was admitted to hospital because of H. alvei bacteremia accompanied by liver and right iliac muscle abscesses. The course was favourable with a 60 day treatment of fluoroquinolone. COMMENTARY: H. alvei is usually considered as moderately or non pathogenic for humans. However, recent descriptions of severe community or nosocomial infections due to H. alvei have challenged this belief. The actual role of H. alvei in human disease remains to be defined.
UNLABELLED: Self-expanding metallic stents is an alternative treatment to colostomy that is the treatment of choice in acute tumoral left colonic obstruction. AIM OF THE STUDY: To compare morbidity, mortality, length of hospital stay and treatment performed after desobstruction using the two methods. PATIENTS AND METHODS: Thirty-three patients admitted for acute obstruction of the left colon were retrospectively separated in two groups depending on the type of intervention performed to treat the obstruction ("colostomy" group: 17 patients and "self-expanding stent group": 16 patients). We studied complications after desobstruction, hospital courses and surgical strategy performed after the acute phase. RESULTS: Time between desobstruction and colectomy was shorter in the "self-expanding stent group" than in the "colostomy group" (18.5 days versus 73 days). Age superior than 75 years and colostomy were the two main factors predicting the risk of definitive colostomy (P < 0.05). Global mean hospital stay was longer in the colostomy group (32.7 days versus 19.3 days, P = 0.02). Two perforations and one local recurrence occurred in the "self-expanding stent group". CONCLUSIONS: Self-expanding metallic stent can decrease the permanent colostomy rate and the number of interventions. The recurrence rate seems to be theoretically increased with the stenting method. Then, colostomy must be done for patients in curative situation. The self-expanding metallic stent should be used as a palliative care.