Comparison of bleeding during trochanteric fracture fixation with mini-invasive or conventional side plate fixation: A randomized controlled trial.

BACKGROUND: Trochanteric fractures are a public health issue due to the aging of the population. Treatment aims to reduce their related morbidity and mortality and to allow an early return to independence. Postoperative anemia is associated with poorer functional recovery and an increased mortality rate. The aim of this study was to assess whether minimally invasive side plate fixation (Minimal Invasive Screw System, MISS™) resulted in reduced perioperative bleeding compared with conventional fixation (Pertrochanteric Hip Screw, PHS™). HYPOTHESIS: We hypothesized that minimally invasive side plate fixation (MISS) would result in reduced perioperative bleeding compared with conventional fixation (PHS). PATIENTS AND METHODS: We conducted an open randomized controlled trial with blinded assessment of the primary outcome. Inclusion criteria were patients aged over 65 years with isolated reducible trochanteric fracture. The 2 surgical implants were of the same shape, the only difference between them being the locking mode of the femoral neck screw on the plate of the MISS device, allowing a percutaneous approach. Primary outcome was perioperative bleeding evaluated with Mercuriali's formula. Secondary outcomes included operating time, scar length, length of hospital stay, radiological criteria such as quality of fracture reduction, implant positioning, bone healing, complications and functional recovery compared between the 2 groups. RESULTS: One hundred and eight patients met the inclusion criteria and were randomized to receive either PHS (n=54) or MISS (n=54). Osteosynthesis with MISS significatively reduced perioperative bleeding (median 243mL, interquartile range [152-410] vs. 334mL [247-430] [p=0.0299]), operating time (65min [57-73] vs. 79min [66-89] [p=0.0002]) and scar length after 45 days (7cm [5-8] vs. 14cm [12-15] [p<0.0001]). There was no statistically significant difference between groups in postoperative complications, revision surgery or serious adverse events. CONCLUSION: Compared with PHS, MISS reduced operating time, perioperative bleeding and scar length with no observed functional difference. LEVEL OF EVIDENCE: I.

Perceived stress, anxiety and depressive symptoms among anaesthesia and intensive care residents: A French national survey.

BACKGROUND: Mental health and well-being is a significant problem for medical students in training. In this study, we aim to estimate the prevalence of anxiety and depressive symptoms, burnout and psychosocial distress in French anaesthesia and intensive care residents. METHODS: A national online observational study used validated questionnaires (Hospital Anxiety and Depression Scale (HADS), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS) and work-related questions (work-hours per week, night shift per month, safety rest after night shift, average time to start and end work, break time and time for lunch) to assess mental health and well-being of French residents in anaesthesia and intensive care. RESULTS: We obtained 519 answers (22.5% of 2302 students), 55% of respondents working in anaesthesia, 41% in intensive care at the time of study. Residents describe certain symptomatology in anxiety (19.8%) and depressive symptoms (7.8%). PSS identifies a perceived high stress (score > 27) for 55.7% of the subjects. The CBI questionnaire identifies 205 (38.9%) residents undergoing burnout, 80.7% working more than 48 h per week and 39.1% more than 60 h. The duration of work per week (> 50 h), gender (female) and on-going training in intensive care are independent risk factors of psychological suffering. Lifestyle and level of training are not statistically identified risk factors. CONCLUSION: This first online survey of French anaesthesia and intensive care residents reveals a significant frequency of anxiety and depressive symptoms, burnout and a link to potential targets of improvement in work conditions mainly related to the number of work hours per week.

When Assessing Intra-Familial Relationships, Are Sociologists, Psychoanalysts and Psychiatrists Really Considering Different Constructs? An Empirical Study.

This paper aimed to look for the existence of a common core when envisaging intra-familial interactions as perceived by adolescents, which could be shared by sociology, psychoanalysis and child and adolescent psychiatry. An empirical study based on a mixed-method design collected the responses of 194 adolescents to the instruction "In the next half hour, would you please write as freely as you wish about your relationships in your family, explaining how things are". All answers were then analyzed and 18 dimensions related to 3 different theoretical frameworks were rated blind using numerical scores by two independent raters from each discipline. Inter-rater reliability was good. A parallel analysis evidenced a strong underlying factor explaining a large amount of variance (>50%). This factor is bipolar, it reflects the level of positivity/negativity in the adolescent's point of view concerning his/her intra-familial relationships. A second factor can marginally be considered (10% of the variance). The 2-factor analysis found one factor related to positive feelings and the other to negative feelings. This finding of unidimensionality supports family study as an intervention science.

Separation, dependance et depression a l'adolescence / Separation, addiction and depression has adolescence

La dépendance est une étape, provisoire mais nécessaire pour la constitution psychique du sujet. C›est une des figures du lien sans laquelle il ne saurait y avoir d›autonomie. Mais la dépendance traduit aussi un état pathologique dans le processus d'adolescence où la capacité à jouer avec l'objet est rabattue au besoin de trouver un objet qui comble, qui masque aussi la détresse du sujet et sa difficulté à se séparer. Nous faisons l›hypothèse que la dépendance pathologique est une façon de lutter contre la dépression et l›angoisse d›effondrement qui lui est sous-jacente.

Separation, dependence and depression in adolescence. Addiction is a step, provisional but necessary for the psychological constitution of the subject. This is one of the forms of relation without which there can be no autonomy. But dependency also reflects a pathological condition in the process of adolescence where the ability to play with the object is replaced by the need to find an object which fills, as well as masks the distress of the subject and its difficulty to be separated. We establish the hypothesis that the pathological dependency is a way to fight against depression and its underlying anxiety of collapse.

Separation, dependance et depression a l'adolescence

La dépendance est une étape, provisoire mais nécessaire pour la constitution psychique du sujet. C›est une des figures du lien sans laquelle il ne saurait y avoir d›autonomie. Mais la dépendance traduit aussi un état pathologique dans le processus d'adolescence où la capacité à jouer avec l'objet est rabattue au besoin de trouver un objet qui comble, qui masque aussi la détresse du sujet et sa difficulté à se séparer. Nous faisons l›hypothèse que la dépendance pathologique est une façon de lutter contre la dépression et l›angoisse d›effondrement qui lui est sous-jacente(AU)

Separation, dependence and depression in adolescence. Addiction is a step, provisional but necessary for the psychological constitution of the subject. This is one of the forms of relation without which there can be no autonomy. But dependency also reflects a pathological condition in the process of adolescence where the ability to play with the object is replaced by the need to find an object which fills, as well as masks the distress of the subject and its difficulty to be separated. We establish the hypothesis that the pathological dependency is a way to fight against depression and its underlying anxiety of collapse(AU)

Restoring psychic containers of identity after a suicide attempt in adolescence.

Suicidal acts during adolescence reveal narcissistic vulnerabilities. The author's observation concerns the quality of ego boundaries, as well as their evolution. Longitudinal studies were conducted on the basis of interviews and projective tests performed within 15 days after the suicide attempt and once again the following year. The quantitative analyses of Fisher and Cleveland's Barrier/Penetration scores on the Rorschach show the evolution of identity mechanisms. The results underscore the importance of restoring psychic containers of identity.

Dependencia y depresión en la adolescencia / Dependence and depression in adolescence

Esta Conferencia propone una hipótesis acerca de lo que parece ser central en la problemática de los jóvenes con consumo abusivo de sustancias tóxicas (como el alcohol o el cannabis): la dependencia que desarrollan en relación con la sustancia como intento de evitar el encuentro y el afrontamiento de la depresión que existe en ellos. Se plantea como pregunta de dónde viene esta depresión que estos adolescentes niegan o buscan eludir y en qué la dependencia tendría relación con la depresión.

Dependencia y depresión en la adolescencia / Dependence and depression in adolescence

Esta Conferencia propone una hipótesis acerca de lo que parece ser central en la problemática de los jóvenes con consumo abusivo de sustancias tóxicas (como el alcohol o el cannabis): la dependencia que desarrollan en relación con la sustancia como intento de evitar el encuentro y el afrontamiento de la depresión que existe en ellos. Se plantea como pregunta de dónde viene esta depresión que estos adolescentes niegan o buscan eludir y en qué la dependencia tendría relación con la depresión. (AU)

A skin on fire: the link between thermal metaphors and early trauma in a case of pedophilia.

On the basis of excerpts from the psychoanalytic psychotherapy of an adult patient convicted of child abuse, the authors suggest the hypothesis that the thermal metaphors that repeatedly appear in the patient's discourse are the marks of early psycho-bodily trauma. These are traces of the patient's burning incestuous relationship with his mother, which led to early fusion of his physical and psychic skins. In this clinical work the authors include the dynamics of transference.

Drawing on psychoanalytic pedagogy: the influence of August Aichhorn on the psychotherapy of adolescents.

The authors locate August Aichhorn's pioneering ideas about the psychodynamics and psychotherapy of adolescents in the context of psychoanalytic pedagogy in Europe in the 1920s and '30s. Strongly influenced by Freud's discoveries and theory, Aichhorn was himself a major influence on the work of Anna Freud and of many other child and adolescent psychoanalytic theoreticians, including Spitz, Mahler, Eissler, Erikson, and Blos. His technique drew heavily on the element of surprise and on the adolescent patient's identification with the analyst, as well as on the use of humor and empathy in treatment. The authors utilize brief vignettes from Aichhorn's descriptions of his practice to illustrate his unique clinical style.

Damage control surgery by keeping the abdomen open during pregnancy: favorable outcome, a case report.

BACKGROUND: Acute abdomen in advanced pregnancy is one of the most challenging surgical situations. In life-threatening situations, despite optimal management, foetus distress and preterm delivery may occur. Although laparostomy is a useful treatment of abdominal sepsis, its successful management has not been reported previously in pregnant women. CASE: 30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal pain. Surgical exploration revealed extensive ischemic bowel necrosis. Multiple segmental resections were performed and abdomen was left open with vacuum assisted dressing, maintained for 48 hours. At the third surgical look the continuity was restored and abdominal wall closed. The foetal condition stayed unperturbed under pharmacologic tocolysis. Pregnancy was carried to full term delivery. CONCLUSION: Open abdomen strategy can be successfully applied in pregnant woman.

A construção dos laços ( ou vínculos) afetivos pais/filhos: uma história de referências repères)

A construção dos laços afetivos entre pais e filhos não se limita a trocas interpessoais, mas inscreve os protagonistas dessa interação em um universo de sentidos que os depassam e os englobam. O registro do reconhecimento de si é o do simbólico. É ele que organiza as relações entre os indivíduos e lhes dá sentido. A identificação à função parental, a saída da adolescência e a entrada no mundo adulto: é assim o verdadeiro acesso à parentalidade. Na época da clonagem e da exaltação narcísica, a questão dos laços afetivos que unem e co-constróem os sujeitos são bem da atualidade.Se escolhemos apresentar a construção dos laços afetivos entre a criança e seus pais como uma história de referenciais; se, por vezes, insistimos em alguns componentes podendo parecer mais técnicos que poéticos, é no sentido de colocar em evidência a complexidade dessa construção que não se saberia reduzir a uma história de amor; mesmo se, como em toda construção de vínculos afetivos entre humanos, o amor e a capacidade de amar e de ser amado estiverem no coração desse processo.(AU)

Linking work: from violence to subjectivization.

For certain adolescents, the eruption of puberty sometimes carries the risk of a break in their psychic life: a break in their impression of continuity in existence, in the investment of their inner world, and in their relation to external objects. When these adolescents are unable to tolerate the discontinuity that accompanies the experience of adolescence, this can lead to pathologies of compulsive breaking away, depression, violence, or psychosis. Linking work, on the contrary, enables adolescence to become a transforming process on the psychic level and contributes to the dynamic character of the therapeutic process.