Umbilical Cord Prolapse in the Prehospital Setting: A Case Report.

Umbilical cord prolapse is an acute obstetric emergency associated with high fetal morbidity and mortality. To avoid poor outcomes, rapid diagnosis with immediate intervention is required, especially in the prehospital setting where resources are limited. In this case report, we describe a 38-year-old woman with umbilical cord prolapse, with a review of appropriate prehospital maneuvers and treatment.

[Proposals to adapt the protection of children to the realities of today]. / Propositions pour adapter la protection de l'enfance aux réalités d'aujourd'hui.

The report titled "40 propositions pour adapter la protection de l'enfance et l'adoption aux réalités d'aujourd'hui" ("Forty proposals to adapt protection of children to the realities of today") was presented in February 2014 by the "Protection de l'enfance et adoption" working group to the Minister for Family Affairs within the framework of the preparation of the French family law. The medical field is an important link in the chain of child protection. Of the 40 proposals, particular attention was paid to the identification of children at risk and to improving the protection of newborns (shaken baby syndrome, unexpected infant death) and to adoption issues.

[Resistance to contraception]. / La résistance à la contraception.

While contraception has been an acquired freedom for more than 10 years, a number of women present clinical manifestations resulting in the restriction or the suppression of this freedom. The symptoms are extremely diversified, from forgetting the pill to severe depression, from repeated infections to personality disorders. If many symptoms may be explained from an organic standpoint, others only derive from an unconscious resistance to contraception. The authors attempt to determine the origins of such resistance, their possible variations and advocate a management protocol for patients presenting this type of disorder.

PIP: A discussion of unconscious psychological resistance to contraception is illustrated by the case of a woman with a 10-year history of use of oral contraceptives and IUDs marked by repeated development of side effects and changes of formulation culminating in a serious depression after tubal ligation at age 35. The woman's postligation complaints of abdominal pain resistant to analgesic treatment were the expression of a serious depressive syndrome that responded poorly to antidepressants. The request for contraception normally contains 2 propositions: the individual desires to have sexual relations, and the individual does not wish to procreate. The logical connection between these 2 propositions at the conscious level is absent at the level of the unconscious, where there is no logic or possibility of reasoning. Forgetting a pill is a relatively minor form of resistance to contraception. Other symptoms, such as pain, vertigo, nausea, nervousness, insomnia, and anxiety with the pill or unexplained pain, repeated local infections, or anxiety and depression with the IUD may be manifestations of the psychological modifications inevitably caused by the psychic symbolism of the contraceptive. The difficulty experienced by certain women in accepting in their unconscious the 2 propositions about contraception causes the symptoms to be produced. Unconscious motives for resistance to contraception may include a woman's dependence on the potential for maternity for her sexual identity, or anxiety at the degree of sexual freedom offered by the contraceptive method. The unconscious elements related to resistance are sometimes open to modification. A study of women undergoing abortion at a center in Rennes indication that 91% failed to use an effective method of contraception at the time of the pregnancy, but that 1 year later 76% had accepted a method. Only 12% at risk of undesired pregnancy were not using a method. A large part of the increased usage was probably explained by contraceptive information provided at the time of the abortion, but the very fact of the abortion may have helped some of the women resolve their feelings of ambivalence about contraception. But 53% of the contraceptive acceptors complained of side effects, mainly anxiety, decreased sexual pleasure, weight gain and menstrual problems. It appears that an abortion may influence the decision to use a method without greatly changing the resistance to contraception. The practitioner wishing to assess the potential tolerance or resistance of a woman to contraception should take the time to discuss her feelings about contraception, menstruation (which signifies absence of pregnancy and thus maternity), and her sexual and emotional life. the dialogue can continue in subsequent visits if the women had complaints about side effects.

[Treatment of chronic pain of the musculoskeletal system by epidural stimulation]. / Traitement des douleurs chroniques de l'appareil locomoteur par neurostimulation épidurale.

In order to reduce refractory chronic pain of the musculoskeletal system, the orthopedic surgeon can stimulate electrically the peripheral nerves or the posterior funiculi of the spinal cord (epidural neurostimulation). The authors specify their current indications for epidural stimulation in the treatment of such painful diseases: radicular pain caused by arachnoepidurites, sequelae of trauma inflicted to the spine and medulla; postoperative lomboradicular pain of mixed source, and distal lesions of the plexus brachialis. The indication for an implant stems from a rigorous strategy which requires more particularly that pain regress by more than 50% under transcutaneous neurostimulation applied for a period of least one month and that the psychological and spinal-cerebral integrity be verified. The surgical procedure comprises two stages: first, positioning of an epidural electrode and, then, insertion of a totally implantable multiprogrammable radiostimulator. Judging from a prospective assessment of 20 cases of postoperative lumbar arachnoepiduritis treated in this way, the results are considered quite encouraging.

[Psychodynamic understanding of anxiety]. / Compréhension psychodynamique de l'anxiété.

Anxiety as a state of arousal--Is it the same thing in pathology as in the ordinary experience of every human being? The outward show of anxiety is evidently the same, but what exactly do we mean by anxiety? Anxiety is one of the less welcome sides of man's superiority over the animals, stemming from a consciousness of one's own being, the freedom to make choices about the future and to plan ahead, the need to develop one's own personality, to create an identity for oneself in an environment where the means for such self-fulfillment appear always to be insufficient. This existential anxiety becomes pathological through symptoms; it manifests a specific weakness for each psychopathological structure. There are two different, but not irreconcilable approaches to understanding the mechanisms of anxiety: one biodynamic , the other psychodynamic. These two approaches should complement rather oppose one another. Anxiety is the cry of a self in the process of becoming, it is expressed through language. Administration of an anti-anxiety drug has a biochemical impact, but this should not be sufficient in itself. When a doctor prescribes an anti-anxiety drug, he should always encourage the patient to talk. Drug therapy thus becomes a means rather than an end in itself: It enables the patient to find the words to express his anxiety.