Migraine de l’enfant et de l’adolescent

Migraine is the most frequent recurrent headache syndrome in children. It is characterized by attacks of intense, throbbing, mostly bilateral head pain, often accompanied by nausea, vomiting, photophobia and phonophobia. Efficacy of drugs for the acute treatment of migraine has not been studied in well-controlled trials. Ibuprofen and nasal spray sumatriptan may effectively alleviate migraine in children and adolescents.     

Effet de Parietaria officinalis sur la cristallisation de l’oxalate de calcium, dans l’urine

In Algeria, the traditional medicine is still widely sought by people with the use of medicinal plants based on recommendations made by it and thereby. The Parietaria officinalis known in Algeria as the common name of Jigsaw stones “fattatet l’hdjar” is commonly recommended in the treatment of urinary stones, whatever the type. This study aims to determine the effect of Parietaria officinalis on oxalo-dependent calcium oxalate crystallization, induced by addition of oxalate in urine of healthy subjects. It appears that in this biological model which is the total urine, the infusion of Parietaria taken at different concentrations, has properties controversial: it is inhibiting the crystallization of monohydrate calcium oxalate and enhances the crystallization of dihydrate calcium oxalate.     

Les échecs de l’extubation

Extubation failure is defined as the need for the reinstitution of ventilatory support within 24 to 72 hours of planned endotracheal tube removal. It occurs in 2 to 25% of extubated patients depending of studied population and modalities used. More often, it is associated to a higher morbidity and mortality. The causes of extubation failure are different of those of spontaneous ventilation trial failure. Compared with patients who tolerated extubation, those who require reintubation have prolonged duration of mechanical ventilation, increased length of ICU and hospital stay, and a higher incidence of mortality in some studies. For these reasons, it is very important to better identify patients at risk to present extubation failure and try not to delay reintubation. Tests designed to identify these patients such as to assess for upper airway obstruction, secretions volume and the effectiveness of cough can help to improve the management of extubation failure. Moreover, rapid identification of patients at elevated risk of extubation failure followed by rapid reinstitution of ventilatory support can improve outcome. These last years, studies showed that use of non invasive ventilation and helium–oxygen mixtures after extubation in patients whose develop respiratory distress can be helpful.     

Perspective de l’enseignement de la médecine d’urgence

Emergency medicine will progress in France from a non-qualifying medical sub-specialty to a full qualifying medical specialty. This progression makes us reconsider the teaching of emergency medicine to all the future emergency physicians in order to ensure the quality of their practice. This article focuses on the scope of practice of emergency medicine and presents the academic aims of the training that should be provided to the future physicians.     

Perspectives sur l’application de l’approche comportementale à la douleur chronique

Résumé  Applications effectives et potentielles de l’approche comportementale à la douleur chronique sont évoquées. L’intérêt de l’approche comportementale pour la problématique de la douleur chronique est mis en perspective avec la nécessité d’une intégration accure du comportementaliste dans les équipes pluridisciplinaires.^a L’auteur remercie le Dr E. Serra pour son accueil, ses conseils et la discussion des points abordés ici, ainsi que le Dr B. Veys pour son accueil bienveillant à l’égard de notre démarche. Ce travail a bénéficié du soutien de l’ALDAP (Association de lutte contre la douleur Amiens Picardie).     

Lésions traumatiques de l’aorte

Traumatic disruption of the aorta is the most frequently observed vascular lesion during blunt chest trauma. The medical and surgical management of such traumatic lesions is in constant evolution. Trans-oesophageal echocardiography is the procedure of choice for mechanically ventilated patients. Its routine use in some emergency departments has permitted the recognition some aorta disruptions ignored up to that point. The reliability of the diagnosis presupposes, however, a certain experience. The principle of early surgery remains valid in the majority of the cases. Initial medical treatment is however sometimes possible, and surgery could be postponed when the rupture is incomplete and hemodynamics are stable.     

Mécanismes de l’effet placebo

Résumé  De nombreuses données indiquent que l’analgésie placebo est sous-tendue par la mise en jeu des systèmes opio?des endogènes. Premièrement, la naloxone, un antagoniste des récepteurs des opio?des, est capable de bloquer la réponse analgésique placebo, qu’il s’agisse d’une douleur surenant dans un contexte clinique ou d’une douleur expérimentale. Deuxièmement le proglumide, un antagoniste des récepteurs de la cholécystokinine (CCK), dont les propriétés anti-opio?des sont bien établies, potentialise l’analgésie placebo vis-à-vis des douleurs postopératoires, et des douleurs expérimentales induites par une ischémie du bras. Troisièmement, une étude en imagerie cérébrale a montré que l’analgésie provoquée par les opio?des et l’analgésie placebo activent exactement les mêmes régions du cerveau. Les opio?des endogènes sollicités par un placebo agissent non seulement sur les mécanismes de la douleur mais aussi sur les centres respiratoires. En outre, nous avons établi récement que l’analgésie placebo vis-à-vis de stimulations nociceptive tant phasiques que toniques s’accompagnait d’une réduction de la fréquence cardiaque. La naloxone bloque complètement et l’analgésie placebo et la réduction concomitante de la fréquence cardiaque. L’ensemble de ces données suggèrent que les systèmes opio?des endogènes activés par un placebo sont capables d’affectur, directement ou non, diverses fonctions, comme les processus douloureux, la respiration et le système cardiovasculaire. La mise en jeu de substances endogènes par les placebos survient également dans d’autres situations pathologiques, comme les troubles moteurs.      

Chirurgie de l’incontinence urinaire à l’effort chez la femme obèse

Obesity is an established risk factor for SUI. Among overweight women, a weight loss program improves urinary incontinence with a reduction in the frequency of self-reported urinary incontinence episodes and may be suggested as a first-line therapy. Success rates after TVT are similar among obese patients and normal-weight patients, and TVT is the prime procedure to treat SUI in obese patients. Obesity does not appear as a risk factor for intra- and postoperative complications.     

Enseignement de l’endoscopie sur simulateur électronique

Patient-based initial training in gastrointestinal endoscopy in university hospitals is somehow limited by ethical, economic and legal concerns. In addition to patient-based training, learning endoscopy is now possible out of medical facilities through organic and non organic simulations. Electronic simulators offer a virtual reality interface combining an endoscope and a processor, that reproduces digestive anatomy, physiology and pathology. Electronic simulators do not provide yet fully accurate and realistic endoscopic views and maneuvers, particularly for therapeutic procedures (hemostasis, polypectomy, ERCP). Moreover, the cost of endoscopic electronic simulators is high. However, randomised controlled evaluations show that electronic simulation plays a role in the early phase of training in upper gastrointestinal endoscopy and colonoscopy. Electronic endoscopic simulation therefore has a potential for improving the quality of care, including during the very first procedures of a novice endoscopist. It still needs technical improvements, a strong commitment of academic trainers, and further clinical evaluation.     

Évaluation de l’activité antioxydante de Berberis vulgaris L.

Natural substances from plants have multiple interests exploited in biotechnology industry both in food, cosmetic and pharmaceutical. These compounds include a large proportion of secondary metabolites that are illustrated in many areas and even in therapy. In this context, we investigated the antioxidant activity of Berberis vulgaris, a plant used in Algeria, and it is particularly used in the Tlemcen region. After preparation of extracts from the root bark of Berberis vulgaris, total alkaloids were analyzed by thin layer chromatography, indicating the presence of six tasks. A quantitative analysis of polyphenols and flavonoids in methanolic extract was carried out, showing a content of 10.48 mg GAE/g of total polyphenols and 2.05 mg CEQ/g of flavonoids. The antioxidant activity of hydromethanolic extracts under reflux and total alkaloids was evaluated using two methods: reducing power and DPPH free radical scavenging. The results showed a high activity of methanolic extract than the total alkaloids, with an IC₅₀ of 1.40 mg/ml.     

Localisation inhabituelle de lymphangiome kystique intra-abdominale : l’appendice

Cystic lymphangioma of the appendix is quite a rare tumor with only a few cases having been reported in the literature. We describe here a rare case of cystic lymphangioma of the appendix, which was unusual in the patient presented with an acute appendicitis. The intra-abdominal location, either retroperitoneal or mesenteric, is rare and only appears in 2?C8% of cases. The definitive diagnosis was provided by histological examination of the surgical specimen. If surgical resection is complete, prognosis is excellent. The aim of this work is to emphasize the uniqueness of the appendicular location.     

Place du magnésium et de l’hélium dans la prise en charge de l’asthme aigu grave

Magnesium sulphate and helium oxygen are adjuvant therapy of potential interest in acute severe asthma. The purpose of this review is to identify their indications in acute severe asthma. Magnesium sulfate plays a role in smooth muscle relaxation, and has anti-inflammatory properties, thereby contributing to relief of airflow obstruction. Intravenous Magnesium sulphate weakly improves spirometric parameters during acute severe asthma, and may decrease subsequent hospitalization rate in both adults and children. Inhaled magnesium sulphate has no identified effect in adults, but may improve spirometric parameters in children with a short duration of severe asthma symptoms associated with hypoxia.In acute severe asthma, helium-oxygen mixture may be used as a propellant gas to improve bronchodilator nebulization, or as an inhaled gas to take advantage of its physicochemical properties which have the potential to improve airway resistance and work of breathing. Helium-oxygen-driven β2-agonist nebulization improves spirometric parameters in acute asthma, provided specific administration modalities are applied. On the other hand, helium-oxygen mixture used as an inhaled gas should not be recommended in the treatment of severe acute asthma, due to the lack of evidence at this time.     

Le genou de l’hémiplégique

Pain, instability and functional impairment related to hyperextension of the knee for former hemiplegic patients are a frequent reason of consultation. There is a link with the expectations and the increase in life expectancy for this population. For hemiplegics with ability to walk, this hyperextension of the knee is often non-existent at the end of the first part of rehabilitation (from stroke to outpatient rehabilitation). It increases with time because of the lack of interest for this not very well-known after-effect. Once the factors are known, an array of therapeutic strategies are suggested by the clinician: rehabilitation, hypertonia management, surgery, orthesis... Making of a short antihyperextension orthesis, associated or without other medical supports, seems to give promising results. An assessment seems to be necessary.