B Acad Nat Med Paris
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B Acad Nat Med Paris · Jan 2004
Historical Article[25 years review of vascular microsurgery evaluation--perspectives].
Free-tissue transfer has become an accepted method for reconstructing complex surgical defects. We review 25 years' experience of this approach. In France, microsurgery was first performed in 1974. ⋯ Teaching of microsurgery is one of our main preoccupations. This is an indispensable technique in all fields of reconstruction. Rigorous training is necessary and much time must be spent before reaching a high level of reliability.
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Thiomersal, also called thimerosal, is an ethyl mercury derivative used as a preservative to prevent bacterial contamination of multidose vaccine vials after they have been opened. Exposure to low doses of thiomersal has essentially been associated with hypersensitivity reactions. Nevertheless there is no evidence that allergy to thiomersal could be induced by thiomersal-containing vaccines. ⋯ To date, none of the epidemiological studies conducted in Europe and elsewhere support this assumption. Although any effort should be made to avoid useless exposure of vaccinees to a potentially toxic compound, it should be emphasized that 1) public communication on this issue has led to a decrease in the hepatitis B vaccination coverage of children born to HBs Ag positive mothers in the US; 2) this issue was not really relevant in France where until 2002, apart from two hepatitis B vaccines, all childhood vaccines were thiomersal-free, and 3) in developing countries using multidose vaccine vials, moving to thiomersal-free vaccines in unidose presentations would represent such an incremental cost that millions of children would no more have access to vaccination. Therefore the World Health Organisation still recommends the use of thiomersal-containing vaccines as part of the expanded programme of immunisation.
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B Acad Nat Med Paris · Jan 2003
Review[Contribution of interventional radiology to the treatment of liver metastases of colorectal cancers (pre-operative portal embolization--percutaneous radiofrequency)].
Selective embolization of portal branches of some liver segments will induce hypertrophy of non embolized segments of the liver. This induced hypertrophy allows us to perform hepatectomy in patients with initially insufficient volume of future remnant liver (FRL). This technique aims at patients with initial FRL volume below 25% of total liver volume, and patient with initial FRL volume below 40% of total liver volume when a diffuse liver disease is present. ⋯ Spreading of this technique is at least partially explained by a relative high local efficacy (90% of small tumor targeted can be destroyed) and a low invasiveness. However, today no benefit in survival has been demonstrated for patients treated with radiofrequency ablation of liver tumors. Consequently, this technique should not be proposed for tumors that can be surgically resected.
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High dose therapy with autologous stem cell transplantation (ASCT) has been extensively used in the past 15 years in multiple myeloma. The IFM 90 trial has shown that autologous bone marrow transplantation (BMT) is superior to conventional chemotherapy in terms of response rate, event free survival, overall survival. Several other randomized studies confirm that ASCT yields superior complete remission and event free survival rates. ⋯ Yet, allogeneic BMT is possibly the only curative therapy. Reports of CR achieved after infusion of donor lymphoid cells in patients relapsing after allogeneic BMT support the concept of a graft versus myeloma effect. Therefore, the objectives of current studies are to reduce transplant related mortality by using earlier BMT, better selection of patients, better graft-versus host prophylaxis or non myeloablative conditioning regimens.
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B Acad Nat Med Paris · Jan 2003
Comparative Study[Adverse drug effects observed at French admissions departments and emergency services (Prospective study of the National Educational Association for Teaching Therapeutics and proposals for preventive measures].
Various studies have shown that adverse drug events (ADE) are a substantial cause of hospital admissions. However, little is known about the incidence and severity of ADE resulting in hospital visits. To address this issue, we conducted a prospective survey in 10 primary care and emergency departments of French public hospitals. ⋯ The most frequently incriminated drug classes were (1) psychotropic agents, including anxiolytics and/or hypnotics, antidepressants and antipsychotics (n = 84, 20.5%), (2) diuretics (n = 48, 11.7%), (3) anticoagulants (n = 38, 9.3%), (4) other cardiovascular drugs (n = 63, 15.4%), and (5) analgesics, including non steroidal antiinflammatory agents (n = 57, 13.9%). The avoidability of ADE could be estimated by an external expert panel in 280 of the 328 cases. In 106 cases (37.9%), ADE was considered to be preventable because a contra-indication or a warning about drug use had not been respected.