Managing severe traumatic abdominal-wall injuries, a monocentric experience.

PURPOSE: Abdominal wall injuries (AWI) is a clinical and radiological diagnosis of fasciomuscular and at times cutaneous defects after abdominal trauma. Their severity encompasses a spectrum of parietal defects, with the most severe being a burst abdomen with eviscerated organs. With the wide use of CT scans in trauma settings, their incidence is being more recognized. Especially in severe AWI, where associated intrabdominal lesions are highly prevalent, many questions about parietal reconstruction arise concerning the timing and type of surgery, and their final hernia recurrence rate. METHOD: A list of severe AWI injuries have been retrieved, all of which were treated in our center. Type of trauma, clinical presentation, surgical technique and follow-up have been included. RESULTS: Eight cases were found with severe abdominal injuries, with an age range of 11-85 years. Road traffic accidents, crush injuries, fall from height, stab and gunshot wounds are included. Seven out of the 8 cases had associated intrabdominal traumatic lesions. Mesh augmentation due to tissue loss was used in three cases. Recurrence rate was estimated around 25%. CONCLUSION: Prompt surgical exploration is required as associated intrabdominal traumatic lesions are highly associated with severe AWI. Even when intrabdominal lesions are ruled out, fasciomuscular defects should be managed during the same hospitalization, to prevent intestinal strangulation and occlusion. Mesh augmentation should only be used when parietal defects include extensive tissue loss preventing tension-free parietal reconstruction.

A longitudinal analysis of methicillin-resistant and sensitive Staphylococcus aureus incidence in respect to specimen source, patient location, and temperature variation.

OBJECTIVE: Seasonal variations in temperature exert strong selective pressure on microorganism population dynamics and should be taken into account in epidemiological studies. The objective of the present study was to characterize the seasonal variation of staphylococcal infections in respect to patient location, specimen source, month of year, and temperature variation. METHODS: A retrospective longitudinal time-series analysis of methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA) was conducted in northeastern Ohio over a 5-year period. Multivariable time-series analyses were performed to detect the variations in the monthly incidence based on location of patients (inpatient, outpatient, and nursing homes), source of specimen (wound, respiratory tract, and urine), time of year (January-December), and temperature variation (average monthly over 5 years). RESULTS: The results indicated a gradual increase in both MRSA and MSSA infections, with outpatient cases representing the majority of cases. If present, the seasonal nature of MRSA infections varied based on specimen source and patient location, with wound infections from outpatients more prevalent in warmer months, and respiratory infections among inpatients more prevalent during colder months. CONCLUSIONS: The current report provides a longitudinal analysis of staphylococcal epidemiology, and in the process, identifies the seasonal nature of infections to be multifactorial, depending on such variables as specimen source and patient location. The seasonal nature of staphylococcal infections appears to be the product of a complex interaction among host, pathogen, and environment.

[Observational study of the initial prescription of level 3 analgesics in cancer patients.]. / Enquête observationnelle sur la primoprescription d'antalgiques de palier 3 chez les patients cancéreux.

To evaluate pain management in cancer patients, a study was conducted examining the treatment circumstances and modalities of initial prescription level 3 analgesics used by 122 French cancer specialists. The rationale for moving to level 3, the implementation and the follow-up were evaluated in 1,038 patients. The reasons underlying the initial prescription were in line with recommendations for clinical practice (WHO, SOR) and the professionals generally preferred molecules with which they were already familiar. Though pain intensity was reduced in 67% of patients, treatment follow-up could have been improved in a number of cases. In particular, titration was not systematically performed, and the interruption of the prescribed treatment (owing to inefficacy or negative side-effects) was not sufficiently timely. The awareness-raising campaigns performed over the past few years should be continued, underlining the importance of early follow-up, notably during the titration phase of level 3 analgesic initiation.

Phenotypic characterization of microbes in the rhizosphere of Alyssum murale.

Metal hyperaccumulator plants like Alyssum murale are used for phytoremediation of Ni contaminated soils. Soil microorganisms are known to play an important role in nutrient acquisition for plants, however, little is known about the rhizosphere microorganisms of hyperaccumulators. Fresh and dry weight, and Ni and Fe concentrations in plant shoots were higher when A. murale was grown in non-sterilized compared to sterilized soils. The analysis of microbial populations in the rhizosphere of A. murale and in bulk soils demonstrated that microbial numbers were affected by the presence of the plant. Significantly higher numbers of culturable actinomycetes, bacteria and fungi were found in the rhizosphere compared to bulk soil. A higher percent of Ni-resistant bacteria were also found in the rhizosphere compared to bulk soil. Percentage of acid producing bacteria was higher among the rhizosphere isolates compared to isolates from bulk soil. However, proportions of siderophore producing and phosphate solubilizing bacteria were not affected by the presence of the plant. We hypothesize that microbes in the rhizosphere of A. murale were capable of reducing soil pH leading to an increase in metal uptake by this hyperaccumulator.

Influence of the zinc hyperaccumulator Thlaspi caerulescens J. & C. Presl. and the nonmetal accumulator Trifolium pratense L. on soil microbial populations.

Metal hyperaccumulator plants like Thlaspi caerulescens J. & C. Presl. are used for phytoremediation of contaminated soils. Since little is known about the rhizosphere of hyperaccumulators, the influence of T. caerulescens was compared with the effects of Trifolium pratense L. on soil microbes. High- and low-metal soils were collected near a zinc smelter in Palmerton, Penn. Soil pH was adjusted to 5.8 and 6.8 by the addition of Ca(OH)2. Liming increased bacterial populations and decreased metal toxicity to levels allowing growth of both plants. The effects of the plants on total (culturable) bacteria, total fungi, as well as cadmium- and zinc-resistant populations were assessed in nonrhizosphere and rhizosphere soil. Both plants increased microbial populations in rhizosphere soil compared with nonrhizosphere soil. Microbial populations were higher in soils planted with T. pratense, but higher ratios of metal-resistant bacteria were found in the presence of T. caerulescens. We hypothesize that T. caerutescens acidifies its rhizosphere. Soil acidification in the rhizosphere of T. caerulescens would affect metal uptake by increasing available metals around the roots and consequently, increase the selection for metal-resistant bacteria. Soil acidification may be part of the hyperaccumulation process enhancing metal uptake from soil.

[Mechanisms of myofascial pain]. / Mécanismes des douleurs myofasciales.

The aim of this paper is to review available data and current hypotheses concerning myofascial pain syndrome pathophysiology and implications for clinical practice. A muscular hypothesis has been proposed for episodic and chronic tension headache as well as for myofascial syndrome and fibromyalgia. These different syndromes may be compared as, besides their frequent combination, they have common features characterized by spontaneous pain, painful points, and lack of objective findings. They must be distinguished because each has its own diagnostic criteria. Pressure algometry appears to be a reliable method for assessing pressure sensitivity in myofascial pain. Pressure pain is not specific to tension headache and can be observed in other chronic headaches. It has not been demonstrated that the trigger points of fibromyalgia are specific in idiopathic cases. It is difficult to find an electrophysiological investigation which is specific for myofascial pain. For daily practice, the clinical approach with interview and examination remain the advisable attitude. Pathophysiological hypotheses help in better understanding of referred pain by sensitization of nociceptive central pathways according to the Ruch convergence projection theory (1965), modified by Mense in 1994. These theories do not however provide an explanation of the primary muscular mechanisms. Implications for myofascial pain patient management is discussed.

[Is there a place for chemotherapy in the initial treatment of cervical cancer? Review of the literature]. / La chimiothérapie a-t-elle une place lors du traitement initial des cancers du col utérin? Revue de la littérature.

Despite their high efficiency in treating cancer of the uterine cervix, surgery and radiotherapy can not cure (local and/or metastatic disease) a certain number of patients with initially adverse risk factors, mostly local or regionally advanced cervical carcinoma (stage III-IVA) or early stage (IB-II) disease with bulky primary lesion or involved regional nodes. Since the 1980s, many investigators have tried to determine whether or not there is any benefit in introducing chemotherapy earlier in the therapeutic plan for these patients: either initially before surgery or radiotherapy (neoadjuvant), or during radiotherapy (concurrent), or after local treatment (adjuvant). In this review we seek to sum up the published data available and to determine if at present there is a place for chemotherapy in the initial treatment of cervical cancer.