Distribution of wild bee (Hymenoptera: Anthophila) and hoverfly (Diptera: Syrphidae) communities within farms undergoing ecological transition.

BACKGROUND: In Havelange (Belgium), two farms are experiencing an ecological transition. We aimed to evaluate the impact of their agricultural activities on insect pollinator communities. This article depicts the situation at the very early stage of the farm transition. This study supports the fact that the maintenance of farm-level natural habitats provides environmental benefits, such as the conservation of two important pollinator communities: wild bees and hoverflies. NEW INFORMATION: Over two years (2018-2019), by using nets and coloured pan-traps, we collected 6301 bee and hoverfly specimens amongst contrasting habitats within two farmsteads undergoing ecological transition in Havelange (Belgium). We reported 101 bee species and morphospecies from 15 genera within six families and 31 hoverfly species and morphospecies from 18 genera. This list reinforces the national pollinator database by providing new distribution data for extinction-threatened species, such as Andrena schencki Morawitz 1866, Bombus campestris (Panzer 1801), Eucera longicornis (L.) and Halictus maculatus Smith 1848 or for data deficient species, such as A. semilaevis Pérez 1903, A. fulvata (Müller 1766), A. trimmerana (Kirby 1802) and Hylaeus brevicornis Nylander 1852.

Targeting the red nucleus for cerebellar tremor.

Deep brain stimulation of the thalamus (and especially the ventral intermediate nucleus) does not significantly improve a drug-resistant, disabling cerebellar tremor. The dentato-rubro-olivary tract (Guillain-Mollaret triangle, including the red nucleus) is a subcortical loop that is critically involved in tremor genesis. We report the case of a 48-year-old female patient presenting with generalized cerebellar tremor caused by alcohol-related cerebellar degeneration. Resistance to pharmacological treatment and the severity of the symptoms prompted us to investigate the effects of bilateral deep brain stimulation of the red nucleus. Intra-operative microrecordings of the red nucleus revealed intense, irregular, tonic background activity but no rhythmic components that were synchronous with upper limb tremor. The postural component of the cerebellar tremor disappeared during insertion of the macro-electrodes and for a few minutes after stimulation, with no changes in the intentional (kinetic) component. Stimulation per se did not reduce postural or intentional tremor and was associated with dysautonomic symptoms (the voltage threshold for which was inversed related to the stimulation frequency). Our observations suggest that the red nucleus is (1) an important centre for the genesis of cerebellar tremor and thus (2) a possible target for drug-refractory tremor. Future research must determine how neuromodulation of the red nucleus can best be implemented in patients with cerebellar degeneration.

Sudden death caused by aortic dissection in a patient with polycystic kidney disease.

A 43-year-old man presented at the emergency medical unit with chest pain. The results of a clinical examination were normal, apart from sternum pain (without radiation) on palpation. The patient had no respiratory problems and the pain was relieved by paracetamol. The electrocardiogram, laboratory tests and chest X-ray were normal. However, the man was found dead the next morning. In the autopsy, we noted the presence of haemopericardium, aortic dissection (starting from the vessel's origin and extended to the aortic arch and on through the diaphragm), polycystic kidney disease and liver cysts. In adult autosomal dominant polycystic kidney disease (ADPKD) patients, the main causes of death are ruptured intracerebral aneurysms, coronary artery disease, congestive heart failure, valvular heart disease and ruptured abdominal aortic aneurysms. Aortic dissection is considered to be rare cause of sudden death in ADPKD sufferers. ADPKD can have serious consequences for the vascular system. The families of confirmed ADPKD sufferers must be informed and screened as early as possible, in order to prevent renal and cardiovascular complications.

[Intensive care anaesthesia practice in the prison environment. Can a prisoner benefit from ambulatory anaesthesia]. / Pratique de l'anesthésie réanimation en milieu pénitentiaire. Un détenu peut-il bénéficier d'une anesthésie ambulatoire ?

Ambulatory anaesthesia is an anesthesia allowing the return of the patient home the same day. Even if the ambulatory hospitalization can, in theory, be applied to a prisoner as to every patient, caution is essential in such approach. Every anaesthetist reanimator doctor practicing in public hospitals may give care to patient prisoners while he is far from dominating all features of the prison world and while he must put down his therapeutic indications. The ambulatory anaesthesia in prison environment does not guarantee full security for the patient. Procedures could be set up between hospital complexes, caretakers practicing within penal middle (Unit of Consultation and Ambulatory Care [UCAC]) the prison service and hospital, the prefecture, to identify possible ambulatory interventions for a patient prisoner and to set up all guarantees of patient follow-up care in his return in prison environment. The development of interregional secure hospital units (ISHU) within teaching hospitals, allows an easier realization of interventions to the prisoners, but exists only in seven teaching hospitals in France.

[How to take up an expertise for medical liability in anaesthesiology?]. / Comment gérer une expertise en responsabilité en anesthésie réanimation ?

Search for responsibility in medicine became everyday. Anaesthetists are particularly exposed and will be, several times, confronted to it during their career. They have to have knowledge of some necessary elements to get to grips with expertise. Expertise can be asked by a penal jurisdiction. In that case, the anaesthetist can be directly and personally implicationed. When expertise is asked by a civil jurisdiction, it concerns anaesthetists, whichever the (liberal or employee of private). Expertise during administrative procedures concern hospital's anaesthetists. It is important to organize a preparatory meeting in any expertise. Praticians must collect together the complete medical file to establish the most exactly possible, chronology of facts. The anaesthetist can be accompanied by medical consultant appointed by the insurance companies and a lawyer. But he does not have to content with be represented by them. Presence in expertise is essential; praticians can so give evidence of their good faith and answer the expert's questions. Vagueness or doubt are never favorable to pratician. It is also, a responsible and respectful behavior toward the patient.

[Craniocerebral gunshot wounds: a study of outcome predictors]. / Les plaies crâniocérébrales d'origine balistique: recherche d'arguments pronostiques.

BACKGROUND AND PURPOSE: A retrospective study about craniocerebral gunshot wounds was done to better identify outcome predictors. METHODS: We reported and analyzed the clinical and radiological data of 18 patients admitted to Le Kremlin-Bicêtre institute for a craniocerebral gunshot wound between January 2000 and December 2005. The Glasgow Outcome Scale (GOS) was used to analyze patient outcome. RESULTS: There were 17 men and one woman, mean age 43 years (range 17-84). Fifteen patients died, two had a GOS equal to 2 and one GOS equal to 3. There were 16 suicides and two murders. All patients with areactive bilateral mydriasis and all patients with Glasgow Coma Scale (GCS) less than seven died except one. The 10 patients with intraventricular hemorrhage died. The bullet crossed the midline for 13 patients and all of them died. None of the patients underwent emergency surgery for the treatment of craniocerebral gunshot wounds because of low Glasgow Coma Scale. CONCLUSIONS: This study shows some interesting prognosis patterns: bilateral areactive mydriasis, GCS less or equal to 7 and bullet trajectory (if crossing the midline) are the most important factors predicting a fatal outcome.

New French legislation governing organ removals for therapeutic and scientific purposes.

In France the general principles of organ donation are: consent, absence of financial gain, anonymity, advertising is prohibited, healthcare safety. As regards organ removals from living persons, a panel of experts is required to give approval. The recipient's spouse, brothers or sisters, sons or daughters, grandparents, uncles or aunts and first cousins may be authorised to donate organs, as well as the spouse of the recipient's father or mother. The donor may also be any person who provides proof of having lived with the recipient for at least two years. As regards organ removals from Deceased Persons for Therapeutic Purposes, removals may be practised if the deceased did not make known their refusal during their lifetime (this may be recorded in the national registry set up for this purpose). The doctor must not seek the family's opinion, but rather ensure that the deceased did not express opposition to organ donation during his lifetime. The rule of presumed consent should apply, unless there is any danger to the health of the general public. This paper describes and discusses in detail the new legislation and its relationship to existing French legal codes.

[Surgery and transfusion in Jehovah's witness patient. Medical legal review]. / Chirurgie et transfusion chez les patients témoins de Jéhovah. Mise au point médico-légale.

The religious convictions of the witnesses of Jehovah leads them to refuse transfusion of blood, of its major components and of blood sparing procedures breaking the physical contact between the patient and his blood. We recall the rules of good practice in case of elective surgery concerning exhaustive information of the patient within multidisciplinary team associating anesthetist and surgeon advised by the forensic pathologist. This consultation must, to our point of view, be concluded by a report which summarizes what is accepted or not by the patient. This report will be initialed by the patient. This consultation can never lead the physician to swear to never use a transfusion whatever the circumstances. In case of emergency if and only some conditions are met (everything was made to convince the patient, vital emergency, no therapeutic choice, therapeutic care adapted to the patient heath status), the physician can be brought to overpass the patient's will to not receive blood transfusion. Current jurisprudence has, to date, never recognized as faulty the physicians having practiced such transfusions whenever they took place within a precise framework.

[Intracranial hemorrhages associated with oral anticoagulant therapy. Analysis of 38 cases]. / Hémorragies intracrâniennes associées à un traitement anticoagulant oral. Analyse de 38 observations.

The major risk of oral anticoagulant therapy is haemorrhage potentially affecting all organs. Bleeding in the central nervous system is a rare but severe complication of anticoagulant therapy. This study aimed to analyse a series of intracranial haemorrhages. This series from the Regional Pharmacovigilance Center of Amiens included spontaneously reported and retrospectively collected cases from January 1999 to December 2000. During this period, 38 cases of intracranial bleeding possibly related to oral anticoagulant administration were reported; 19 women and 19 men, median age 69.5 (29 to 87) years. In 34% of the cases, patients died and in 18% neurologic sequelae were still present at the time of the evaluation. In 21 cases (62%), the INR (International Normalized Ratio) was higher than the therapeutic range recommended for the indication. Among the most frequent risk factors, hypertension and recent minor trauma are highlighted in this series. In 17 cases, oral anticoagulants were associated with potentially potentiating drugs. Mental status changes or headache were prominent early symptoms which had often been present for days. Our data confirm that anticoagulant-associated intracranial haemorrhages are not rare, can be severe, potentially fatal and are probably underestimated by physicians. The fact that more than 50% of patients in this series were overanticoagulated at the time of bleeding suggests that many cases of intracranial haemorrhage could be prevented by improved anticoagulation control. Epidemiological studies are needed in order to prospectively evaluate the incidence of this type of complication and its avoidance. The value of anticoagulation clinics can be discussed.

[Headaches after spinal anesthesia: prospective multicenter study of a young adult population]. / Céphalées postrachianesthésie: étude prospective multicentrique dans une population d'adultes jeunes.

OBJECTIVE: We assessed the occurrence of post-dural puncture headache (PDPH) in a group of young adults following spinal anaesthesia using a 24-gauge Sprotte needle. STUDY DESIGN: Prospective, multicentre, non-randomized study. PATIENTS: This 9 month-long study, included 1,122 patients less than 50 years-old, consisting of 502 women and 620 men. METHODS: Assessment of PDPH after 48 hours and 7 days. RESULTS: PDPH occurred in 0.8 percent of patients. There was no statistically significant difference in terms of age group or gender between the patients. Incidence of PDPH did not depend on type of anaesthetic solution, puncture level or ease of puncture. DISCUSSION: The use of 24-gauge Sprotte needles was associated with a low rate of puncture difficulties. Usual predisposing factors for PDPH, such as age below 50 years and female gender do no longer apply with this type of needle. The rate of puncture difficulties was low (6.7 percent), in contrast with ultra-fine 27 or 29 gauge needles, which sometimes result in puncture failure. Acceptance of the technique was excellent, as 99.38 percent of patients were satisfied. CONCLUSION: The indications of spinal anaesthesia could be extended to young patients, whatever their gender, using a non-traumatic 24-gauge Sprotte needle.

[Objectives of consultation in anesthesia]. / Objectifs de la consultation d'anesthésie.

Recently developed in France (1970), pre-anaesthetic consultation continues to gain in importance because of a number of considerations. Psychological considerations: Consultation provides information about the patient to be operated, wins the patient's co-operation for his/her preparation for operation, and takes some of the drama out of surgery and anaesthetic. Medical considerations: More complete pre-operative examination (discovery of hereditary defects, and current medication) carried out by means of a long and very methodical interrogation, difficult to do at the patient's bedside. The best and most accurate possible assessment of the anaesthetic risk will reduce per- and post-operative complications or at least reduce their effects by better prevention and preparation of the patient, notably in the case of patients with respiratory problems, following possible complementary examinations or other specialized consultations. Anaesthetic considerations: By means of the choice and discussion of an anaesthetic technique according to the patient's own wishes, the anaesthetic risk, the type of hospitalization, especially in ambulatory anaesthetic, when pre-anaesthetic consultation is indispensable. Care coordination: The anaesthetist doctor assumes a double role of clinician and coordinator with the surgical team, the other specialists, and especially the general practitioner whose work he will continue when the patient is hospitalized, and who will have a leading role in the pre-operative preparation of the patient, and the realization of complementary examinations often carried out at home. The consultation makes for a per-operative approach which is carried out earlier, is more complete and more humane.