[Recovery after gynaecological surgery in French-speaking Belgium : survey and recommendation of the GGOLFB surgical working group]. / Convalescence après chirurgie gynécologique en Belgique francophone : sondage et recommandations du groupe de travail de chirurgie du Groupement des Gynécologues et Obstétriciens de Langue Française de Belgique.

Since the introduction of laparoscopy and mini-invasive techniques, gynaecological surgery has largely evolved. However, post-operative recommendations still remain very restrictive with poor evidence from literature. The survey, performed by the GGOLFB surgical working group, shows that the post-operative advices to the patients are very heterogeneous for the sick leave period as for more specific advices like the period of disallowance of sexual intercourse, bathing and weightlifting. It is nevertheless fundamental to prescribe clear and precise advices to patients, from the first pre-operative consultation on, which will substantially improve the perception of their recovery and promote a return to their normal activity under good conditions. It is not necessary to be too restrictive concerning certain activities in the post-operative period, neither to give too long periods of work incapacity because it may have a negative impact on their quality of life. This survey and the data from literature helped our surgical taskforce group to propose and develop harmonised recommendations on recovery and work incapacity after gynaecological surgery, taking into account the actual surgical practice in 2020.

La chirurgie gynécologique a fortement évolué depuis l'introduction de la laparoscopie et le développement de la chirurgie mini-invasive. Les recommandations post-opératoires sont souvent assez restrictives, avec peu d'évidence dans la littérature sur le bien-fondé de ces limitations. Notre sondage auprès des gynécologues francophones de Belgique montre que les consignes post-opératoires délivrées aux patientes sont très hétérogènes, aussi bien pour les durées d'incapacité de travail que pour des consignes plus spécifiques sur la durée d'absence de port de charges, de bains et de rapports sexuels. Il est pourtant fondamental de délivrer aux patientes des consignes précises, dès la consultation préopératoire, afin d'améliorer le vécu de leur convalescence et favoriser un retour aux activités dans de bonnes conditions. Il n'est pas non plus nécessaire d'être trop restrictif dans la reprise de certaines activités en postopératoire ni de recommander des incapacités de travail trop longues car elle peuvent avoir un impact négatif sur la qualité de vie des patientes. Au regard du sondage et de la revue des données de la littérature, notre groupe de travail propose des recommandations harmonisées sur la convalescence et l'incapacité de travail après chirurgie gynécologique, tenant compte des pratiques chirurgicales recommandées en 2020.

[Heart failure patterns in Djibouti: epidemiologic transition]. / Insuffisance cardiaque chez l'adulte à Djibouti : la perspective d'une transition épidémiologique.

BACKGROUND: The features of heart failure (HF) in Djibouti have not been well described. We sought to document the current patterns of HF here. METHODS: We prospectively included Djiboutian adults hospitalized for HF in the French Military Hospital (Djibouti) from August 2008 through December 2010. RESULTS: Of 1688 adults hospitalized in the medical department, 45 (2.7%) had symptomatic HF: 38 (84%) men, mean age 55.8 years (range 27-75). Twenty-five (56%) patients were initially hospitalized for acute pulmonary edema. The underlying diseases included coronary artery disease (CAD) (62%), hypertensive heart disease (18%), rheumatic valvular disease (13%), and primary dilated cardiomyopathy (7%). Their cardiovascular risk factors included tobacco use (53%), hypertension (69%), diabetes (47%), and hypercholesterolemia (51%). Patients in the CAD group were older, and had diabetes more often (p<0.01). All khat chewers (53%) were males and smokers. Mean left ventricular ejection fraction (LVEF) was 39 ± 14%. During follow-up (14.4 ± 9 months), 8 (18%) patients died, 9 (20%) were again hospitalized for HF, and 3 (7%) had ischemic strokes. One month after discharge, the New York Heart Association (NYHA) class was II for 40%, III for 44%, and IV for 16%. Higher NYHA classes and dilated cardiomyopathy were both associated with poorer outcomes (p<0.03). CONCLUSION: In hospitalized Djiboutians, most HF patterns are similar to those in industrialized countries. CAD is more prevalent than previously reported in African patients with HF.

[Whole-blood transfusion for hemorrhagic shock resuscitation: two cases in Djibouti]. / Transfusion de sang total pour la réanimation du choc hémorragique: à propos de deux cas à Djibouti.

Hemorrhagic shock requires early aggressive treatment, including transfusion of packed red blood cells and hemostatic resuscitation. In austere environments, when component therapy is not available, warm fresh whole-blood transfusion is a convenient treatment. It provides red blood cells, clotting factors, and functional platelets. Therefore it is commonly used in military practice to treat hemorrhagic shock in combat casualties. At Bouffard Hospital Center in Djibouti, the supply of packed red blood cells is limited, and apheresis platelets are unavailable. We used whole blood transfusion in two civilian patients with life-threatening non-traumatic hemorrhages. One had massive bleeding caused by disseminated intravascular coagulation due to septic shock; the second was a 39 year-old pregnant woman with uterine rupture. In both cases, whole blood transfusion (twelve and ten 500 mL bags respectively), combined with etiological treatment, enabled coagulopathy correction, hemorrhage control, and satisfactory recovery.

[Diabetic ketoacidosis with a fatal issue: is it a MODY3 (maturity-onset diabetes of the young type 3)?]. / Acidocétose diabétique d'évolution fatale: serait-ce un MODY3 (maturity-onset diabetes of the young de type 3)?

Ketoacidotic coma is one of the possible diabetes mellitus first symptoms. It results from complete or relative lack of insuline and is often associated with type 1 diabetes. The authors report a case of a 45-years old woman with inaugural diabetes of which atypical features have motivated the study of MODY gene (maturity-onset diabetes of the young). Gly574ser polymorphism in the HNF-1alpha gene was found, in homozygous state, and the question of the responsibility of this polymorphism in this diabete is asked.

[Ectopic ACTH syndrome and severe hypokalaemia]. / Hypokaliémie sévère au cours d'un syndrome de Cushing paranéoplasique.

Cushing's syndrome is rare and remains a challenge to diagnose. Particularly difficult are the differentiation between Cushing's syndrome and Pseudo-Cushing's states and between the two forms of ACTH dependent Cushing's: Cushing's disease and ectopic ACTH syndrome. We report the case of a patient diagnosed with a metastatic small cells lung carcinoma associated with ectopic ACTH-syndrome. Hypokalaemia was a clue to diagnosis. We focus on critical questions addressing diagnosis and differential diagnosis of Cushing's syndrome and we explain the mechanism of hypokalaemia.

[Variations of plasma concentrations of h-FABP during a muscular exercise]. / Variations des concentrations plasmatiques en h-FABP au cours d'un exercice musculaire intense.

OBJECTIVE: To test whether heart-Fatty Acid Binding Protein (h-FABP) is a useful plasma marker for the detection of acute coronary syndrome during muscular exercise. METHODS: Plasma concentrations of h-FABP were measured in 42 volunteers before and after muscular exercise (military aptitude test). Myoglobin and troponin Ic were measured for comparison. RESULTS: Significant increase were found in plasma myoglobin (mean = 195,9 microg/L) and h-FABP (mean = 5,71 microg/L). Myoglobin and h-FABP concentrations were already significantly elevated (p < 10(-6)) at 60 minutes after exercise and h-FABP concentrations were superior to baseline values in 15 volunteers. Whereas h-FABP decreased to normal levels within 24 hours, myoglobin remained elevated in 12 volunteers. The myoglobin to h-FABP ratio in plasma is between 8,0 and 57,0 which is different from the reported plasma ratio after myocardial injury (<6). CONCLUSION: h-FABP can be used to exclude an acute coronary syndrome during exercise. The myoglobin to h-FABP ratio seems to be useful to identify the type of muscle injured. New studies are necessary to evaluate its diagnostic accuracy.

[Heart fatty-acid binding protein (h-FABP): a new cardiac marker]. / Un nouveau marqueur cardiaque: la heart fatty-acid binding protein (h-FABP).

Heart Fatty-Acid Binding Protein (h-FABP) is a small cytosolic protein that is abundant in the heart and found at lower concentrations in muscle or in the brain. h-FABP is released into the circulation shortly after the onset of ischemia. Several studies indicate its usefulness in cardiology: exclusion of acute myocardial infarction, detection of reperfusion, prognostic value... A rapid immuno-chromatographic assay (Cardiodetect) was recently commercialized in France with a result obtainable within 15 minutes. We review the strengths and weakness of h-FABP for detecting myocardial injury.

Analysis of gender differences in the auditory brainstem response.

This study examined the effects of hormones, head size, and oral temperatures on latencies and amplitudes of the auditory brainstem response in 10 young women, 10 young men, and 5 postmenopausal women. Significant gender differences between men's and women's auditory brainstem responses were confirmed. Men showed longer latencies and smaller amplitudes than women. Results showed that oral temperature has little effect on auditory brainstem response latencies and amplitudes. Head size affects waves III, V, and the amplitude of wave V, but is not entirely responsible for the gender latency difference. By examining young women with normal monthly hormonal cycles, significant changes in the absolute latencies of wave V were observed. These changes were correlated with hormonal changes as measured from venous blood samples. It was concluded that the etiology of the gender difference is a combination of hormonal and head-size differences.