B Acad Nat Med Paris
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Analysis of the two laws in favour of the handicapped persons in France, their description, the necessary reforms....
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Septic shock is one of the leading cause of death in modern countries. Scientists have made huge improvement in the understanding of mechanisms of inflammation, and the sequence of activation of the various pro and anti-inflammatory markers is now well known. By contrary, physicians have failed to improve survival from septic shock, in spite of the development of specific targets of the various points of the cytokine cascade sought to have a key role in host survival to sepsis. ⋯ More recent findings highlighting the role of the integrity of the hypothalamic-pituitary -adrenal axis to appropriately respond to a septic insult, have led to a reappraisal of the use of steroids in septic shock. Several high quality randomised controlled trials have evaluated the efficacy and safety of a prolonged treatment with low dose hydrocortisone in severe sepsis. These trials strongly suggested that this strategy of corticotherapy reduced the morbidity of septic shock and may favourably affect survival from septic shock.
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In recent years, considerable improvement has been achieved in the field of mechanical ventilation. A lot of experimental and clinical research has been done to reduce the adverse effects of mechanical ventilation. ⋯ Pressure-assisted ventilatory modes, such as pressure support have been introduced, resulting in better patient-ventilator synchronisation, good tolerance and easier weaning process. Pressure support is also a largely used mode in noninvasive ventilation which has been proved to improve outcome in chronic obstructive pulmonary diseases.
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B Acad Nat Med Paris · Jan 2000
Biography Historical Article[One hundred years ago --Jules Fontan and the wounded heart].
On the event of the centennial of the first wound of the left ventricule cured by suture, the author recalls the conditions under which Jules Fontan, surgeon of the Navy, obtained this memorable success. He recalls the first observation and analysed the obstacles which this surgeon had to overcome to finally open the era of surgical treatment of heart wounds caused by knife fights. A comparative study of diagnostic and therapeutic approaches implemented one hundred years later highlights the advances made in the area of heart wound surgery and also in planned heart surgery for which the 20th century will remain of all achievements.
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B Acad Nat Med Paris · Jan 2000
[Conclusions. The precautionary principle: its advantages and risks].
The proposed extension to health of the precautionary principle is the reaction to two social demands: the desire for greater health safety and for more transparency in the decision making process by associating the public. In medical care, all decisions are based on the balance between cost (dangers induced by the treatment) and benefit (the therapeutic effect). It is as dangerous to overestimate the cost, in other words the risks, as it is to underestimate them. ⋯ The precautionary principle will also impose new obligations on the State, which also must conform to the requirements of proportionality between risk and action, transparency and information in the field of care and health. The application of the precautionary principle will require good judgment because the way it is implemented will determine whether its outcome will be for the better or the worse. That is why it is indispensable that jurists, medical practitioners, and scientists work together so that the precautionary principle will be as precisely defined and codified as possible.