骨质疏松与勃起功能障碍风险相关性的Meta分析

目的采用Meta分析的方法,评估骨质疏松与勃起功能障碍(ED)之间风险相关性。方法检索PubMed、Cochrane Library、Embase、Web of Science、Springer Link、中国知网、万方等数据库,检索时间截止至2018年12月,数据提取由2名研究员独立进行,以避免错误或遗漏。任何分歧可通过小组商讨共识或咨询第3位研究员来解决。对纳入的研究采用Stata 12.0软件进行Meta数据分析。结果最终有4篇病例-对照研究文献符合此Meta分析的纳入标准。其中共纳入了4702例ED患者。Meta分析结果显示:各研究间不存在显著异质性(I2=46.4%,P=0.133)。因I2<50%,从而对该Meta分析采取固定效应模型。ED组骨质疏松的患者显著高于非ED组患者(P<0.05)。采用漏斗图法和Begg、Egger检验对对纳入研究的发表偏倚进行评估,最终未发现发表偏倚。敏感性分析采用逐次剔除法,合并效应值RR取值于1.48~1.61,剔除后的研究对结果影响不大,总合并效应值与其基本一致。结论通过研究发现ED患者合并骨质疏松的风险明显高于非ED患者,ED患者可能存在雄性激素与雌性激素水平的失平衡,而这种平衡被打破后,可能会让骨质疏松的发生率升高。这也侧面反映了性激素对于骨质疏松的重要性。     

强骨胶囊与维生素D对骨质疏松性骨折患者治疗有效性及安全性的系统评价

目的系统评价强骨胶囊与维生素D治疗骨质疏松性骨折的有效性及安全性。以期为临床骨质疏松性骨折患者的药物选择提供参考。方法计算机检索Pub Med、Web of science、Cochrane图书馆、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、万方数据库。搜集强骨胶囊与维生素D用于治疗骨质疏松性骨折的随机对照试验(RCT),检索年限均为建库以来至2017年1月27日。由两位研究者独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入3个RCT,包括510例患者。Meta分析结果显示:强骨胶囊组患者的骨折愈合时间显著低于维生素D组,两组比较差异有统计学意义[MD=-3.68,95%CI(-4.60,-2.76),P0.00001]。强骨胶囊组的治疗后股骨颈骨密度(bone mineral density,BMD)高于维生素D组,且差异均具有统计学意义[MD=0.03,95%CI(0.01,0.04),P=0.0002]。强骨胶囊组患者轻度不良反应发生数显著高于维生素D组,两组比较差异有统计学意义[OR=23.89,95%CI(4.56,125.11),P=0.0002]。结论强骨胶囊可以减少骨质疏松性骨折患者的骨折愈合时间,增强骨密度,但相较于维生素D,仍需注意胃肠道的不良反应。     

应用FRAX工具评估类风湿关节炎患者骨质疏松性骨折风险

目的应用骨折风险评估工具(FRAX)评估类风湿关节炎(RA)患者10年内主要骨折及髋部骨折的发生率及相关危险因素。方法回顾性分析2013年至2019年于北京市石景山医院风湿免疫科就诊且资料完整的RA患者206例,应用FRAX工具评估患者10年内主要骨折及髋部骨折发生风险。结果 (1)病程长、绝经时间长、病情活动度高及曾应用激素的RA患者10年内主要骨折及髋部骨折风险更高;(2)糖皮质激素日剂量及使用时间与RA患者10年内主要骨折及髋部骨折风险无明显相关性;(3)RF及抗CCP阳性与阴性患者间10年骨折发生风险无明显差异。结论绝经时间长、病程长、病情活动度高的RA患者骨质疏松性骨折发生风险更高,而FRAX模型中并未考虑到这些因素,因此,可能低估了这部分患者的骨折风险,临床工作中对这部分患者更应该防治骨质疏松及骨质疏松性骨折。     

高尿酸水平与勃起功能障碍相关性的Meta分析

目的:本研究通过Meta分析对血高尿酸(UA)水平与勃起功能障碍(ED)的相关性进行评价分析。方法:通过检索维普(VIP)、万方、中国知网(CNKI)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library等数据库收集UA与ED相关性的研究,检索时限从各个数据库建库到2018年5月31日。采用Stata 10.0对数据进行分析。结果:共纳入了6篇文献,共纳入病例2 720例,其中高UA组1 592例,对照组1 128例。结果显示高UA组ED风险明显增加(OR=2.10,95%CI:1.18~3.74,P0.05)。敏感性分析显示结果稳定,Beger’s(P0.05)和Egger’s(P0.05)检验提示纳入文献无明显发表偏倚。结论:高UA水平可能是ED的危险因素,由于本文纳入文献存在一定的异质性,因而还需要更多大样本的前瞻性研究来证实相关结论。     

右归丸联合西药治疗骨质疏松症的Meta分析

目的系统评价右归丸联合西药治疗骨质疏松症的有效性和安全性,以期为临床决策提供参考。方法检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据库)、中文科技期刊数据库(维普网)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrance Library建库至2020年1月7日有关右归丸治疗骨质疏松症的随机对照试验文献,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用Rev Man 5.3以及stata14.0进行Meta分析,发表偏倚采用Egger检验。结果共纳入11个研究,均为随机对照试验,包括1 066例骨质疏松症患者。Meta分析结果显示,右归丸联合西药治疗骨质疏松症时,在提高总有效率(RR=1.29,95%CI:1.21～1.39,P0.000 01)、改善骨密度含量(SMD=-0.77,95%CI:0.28～1.25,P=0.002)、降低新发脆性骨折风险(RR=0.29,95%CI:0.11～0.51,P0.000 1)方面均优于西药对照组,右归丸联合西药组血钙浓度(MD=-0.09,95%CI:-0.16～-0.02,P=0.01)低于西药对照组,Egger检验(P=0.4540.05)无明显发表偏倚。结论右归丸联合西药治疗骨质疏松症优于单纯使用西药治疗,但仍然有待高质量、大样本的随机对照试验予以进一步证实。     

老年人骨质疏松性骨折的风险预测

目的了解老年人骨质疏松性骨折的风险与骨矿密度(BMD)的关系,为预测发生骨质疏松性骨折的风险提供科学的指标。方法对1020例年龄≥60岁的老年人骨质疏松症患者进行定量超声骨密度仪(QUS)测定跟骨的BMD值,将数据输入计算机进行统计学处理分析。结果骨折发生例数随BMD的T值降低呈负相关,骨质疏松性骨折患者百分比分别在Ⅰ区间和Ⅱ区间均与Ⅲ区有非常显著性差异,当BMD的T值≤-3SD骨折发生例数呈显著增加(r=-0.973,P<0.01)。结论老年人BMD的T值为-3.0SD时,骨折发生率呈明显上升,临床上可将老年人的BMD的T值低于正常1个标准差(-3.0SD)作为预测骨质疏松性骨折的风险指标。     

应用FRAX工具评估系统性红斑狼疮患者骨折风险及相关因素分析

目的探讨骨折危险性评估工具(FRAX)评估系统性红斑狼疮(SLE)患者骨质疏松性骨折风险并进行相关因素分析。方法纳入2018年1月至2019年6月我院治疗的90例SLE患者以及60例正常体检人员,分别设为研究组与对照组。采用双能X线骨密度仪测定骨密度,比较两组骨密度差异;采用FRAX评估SLE患者骨质疏松性骨折风险,按骨折风险10%、10%分为低风险组与中高风险组,采用Logistics回归分析探讨SLE患者骨质疏松性骨折风险的独立影响因素。结果 SLE组骨密度均显著低于对照组,差异有统计学意义(P0.05)。SLE组10年主要骨质疏松性骨折风险为(9.23±2.97)%,显著高于对照组的(3.09±1.04)%,差异有统计学意义(P 0.05)。其中SLE患者10年骨折低风险组58例,骨折风险为(7.69±0.95)%;中高风险组32例,骨折风险为(13.21±2.75)%。中高风险组与低风险组在年龄、体重、病程≥2年、体质指数、血清白蛋白、双膦酸盐药物使用率、SLEDAI评分差异具有统计学意义(P0.05);多因素分析显示:年龄≥70岁、病程≥2年、SLEDAI评分≥10分是SLE患者骨质疏松性骨折风险的独立影响因素。结论 SLE患者骨密度低于正常人群,10年主要骨折风险高于正常人群;其中年龄≥70岁、病程≥2年、SLEDAI评分≥10分均可增加骨折风险。     

BMD、OSTA与FRAX®预测绝经后女性骨质疏松性 骨折风险的比较研究

目的比较BMD、OSTA与FRAX(不含BMD模型)预测绝经后女性骨质疏松性骨折风险的准确性,为选择适合我国绝经后女性骨质疏松性骨折风险工具提供研究依据。方法 2011年1月至2011年12月,以首都医科大学附属北京友谊医院就诊并接受DXA骨密度检查的绝经后女性为研究对象,连续纳入1497例,建立队列。基于基线数据,以就诊时发生骨质疏松性骨折与否为参考标准,绘制ROC曲线,比较BMD、OSTA及FRAX评分预测骨质疏松骨折发生风险的准确性。结果发生骨折组(n=343)患者的BMD,OSTA评分与FRAX评分均低于未发生骨折组(n=1154),且差异均有统计学意义。BMD、OSTA及FRAX评分(不使用骨密度的主要部位FRAX评分)预测骨折风险的ROC曲线下面积分别为0.654(95%CI:0.621-0.687),0.629(95%CI:0.595-0.663)和0.907(95%CI:0.888-0.926),最佳诊断截点值分别为-1.25,-1.90和3.65%。结论不使用骨密度的主要部位FRAX评分可用于我国绝经后女性的骨质疏松性骨折风险评估,但诊断截点值为3.65%,远低于WHO推荐的20%,其原因需要进一步研究。     

FRAX评估类风湿关节炎患者骨折风险及相关临床危险因素的研究

目的运用FRAX探究中国RA患者骨折风险及相关临床危险因素。方法纳入52例RA、47例p SS以及41例体检健康者分别为RA组、p SS组、对照组,RA组患者检测ACPA、RF、ESR、CRP并计算DAS28-ESR、HAQ-DI,所有纳入者以双能X线吸收测定法测定骨密度并通过FRAX官方网站预估10年骨折风险。所有统计分析采用SPSS统计软件。结果 FRAX相关骨折危险因素包括身高、吸烟、饮酒、既往骨折、父母骨折,在3组间差异未见统计学意义。RA组糖皮质激素累积服用天数高于p SS组(P0.05)。通过FRAX无论是否结合骨密度评估,RA组主要骨质疏松性骨折风险及髋关节骨折风险均较对照组高(P0.01),主要骨质疏松性骨折风险亦较p SS组高(P0.05或P0.01)。通过FRAX结合骨密度评估,从年龄、糖皮质激素、绝经方面分析,RA组主要骨质疏松性骨折及髋关节骨折风险均较对照组高(P0.05或P0.01)。通过FRAX结合BMD评估RA组10年主要骨质疏松性骨折风险发生率分为低危、中危、高危组,ACPA、RF、ESR、CRP、DAS28-ESR、HAQ-DI在三组中均值呈上升趋势,差异均有统计学意义(P0.01)。结论 RA患者骨折风险评估可结合FRAX与骨密度;长期、大量服用糖皮质激素以及高龄、绝经后女性RA患者更应重视骨折风险评估;有效控制RA疾病活动度、改善关节功能情况有助于骨质疏松性骨折的预防。     

雄激素受体CAG重复多态性与BPH和PCa相关性的meta分析

目的:通过meta分析探讨雄激素受体(AR)基因CAG重复多态性与良性前列腺增生(BPH)和前列腺癌(PCa)发病风险的关系。方法:检索国内外大型数据库发表的AR基因CAG重复多态性与BPH和PCa相关性的文献,基于异质性检验的结果,分别采用M-H固定效应模型和随机效应模型合并比值比(OR)效应量,采用Begg和Egger偏倚分析评估本项meta分析的发表偏倚,系统评价AR基因CAG重复多态性与BPH和PCa发病风险的关系,并按种族进行分层分析。结果:检索获得文献29篇,最终纳入4篇符合条件的文献,累计BPH患者485例、PCa患者767例、正常对照组709例。BPH组和正常对照组间不存在异质性,M-H固定效应模型合并效应量后提示低CAG重复多态性与BPH无相关性。PCa组和BPH组及对照组间均存在异质性,随机效应模型提示低CAG重复多态性与PCa的风险呈正相关(OR PCa/对照=1.45,OR PCa/BPH=1.86,OR PCa/(BPH+对照)=1.66)。种族分层的亚组分析提示,低CAG重复多态性与PCa发病风险在种族间存在差异。Begg和Egger偏倚分析显示各组比较中均无显著发表偏倚。结论:AR受体低CAG重复多态性与PCa发病风险呈正相关,与BPH发病风险无相关性。     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.