Diminution de l’expression monocytaire de HLA-DR et risque d’infection hospitalière

Objectives

The aim of this bibliographic review is to evaluate the usefulness of the measurement of HLA-DR expression on circulating monocytes (mHLA-DR) in predicting the development of nosocomial infections and unfavourable outcome in critically ill patients.

Data source

References obtained from the medical database PubMed^® in English and in French were reviewed. The keywords included separately or in combination were: HLA-DR antigens, sepsis, trauma, injuries, wounds, burns, stroke, pancreatitis, postoperative, prognostic, immunity, monocytic.

Data extraction

Data in selected articles were reviewed, clinical and basic science research relevant information were extracted.

Data synthesis

Low mHLA-DR expression appears as a marker for monocytic dysfunctions and immunosuppression, temporarily present in the majority of critically ill patients admitted to the ICU (sepsis, trauma injuries, postoperative, burns, pancreatitis and stroke). The decrease in mHLA-DR expression is a predictor of septic complications in all these clinical conditions. However, no predictive threshold value could be determined regarding unfavourable outcome.

Conclusion

The monitoring of mHLA-DR expression could be a biomarker to detect ICU patients at high risk of developing secondary nosocomial infections. Those patients could probably benefit of preemptive strategies to prevent these infections.     

Organisation de l’anesthésie des enfants dans un hôpital non pédiatrique

The author reviews the guidelines and the possible organization of anaesthesia and surgery in a non-paediatric hospital.     

Prise en charge préhospitalière de l’arrêt cardiaque de l’enfant et du nourrisson : enquête nationale de pratique

Introduction

After the publication of new recommendations for cardiopulmonary resuscitation (2005 guidelines and 2006 French recommendations), we conducted a study amongst EMS teams concerning their approach with children and infants, nationwide. The objective was to measure the level of knowledge of guidelines and practice.

Methods

The online questionnaire was offered to emergency physicians belonging to the French emergency database, between November 1st and December 15th 2007. Incomplete questionnaires were excluded from the study. We recorded: profile of personnel, knowledge of guidelines, basic CPR and advanced CPR parameters.

Results

Four hundred and thirty-nine questionnaires were analyzed. Personnel was aged under 40 in 50.2 %, with 2–5 years experience in prehospital emergency care (57.6 %); 51,3 % declared having had training in pediatric CPR. A minority of subjects declared knowing the 2005 Guidelines (35 %), more the French 2006 recommendations (62.5 %). Basic CPR: transition age child/adult known in 30.3 %. Compression/ventilation ratio: 30/2 for one rescuer in 50.2 % (child), 46.5 % (infant); 15/2 for two or more rescuers in 57.6 % (child), 48 % (infant). AED age for use (1 year old) known in 59.8 %. Advanced CPR: epinephrine dose known in 89.3 % (intravenous) and 34.3 % (tracheal). External shock known in 57.2 %.

Conclusion

This study emphasizes the lack of knowledge, especially with regard to first aid. Formations will be developed.     

Décompression du nerf médian assistée par endoscopie dans le syndrome pronateur et le syndrome de Kiloh-Nevin : technique chirurgicale

State of the art

The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression.

Material and surgical technique

Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique.

Results

Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development.

Conclusion

Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.