Prise en charge des fistules anales au cours de la maladie de Crohn

Anoperineal abscesses and fistulas can occur during the course of Crohn’s disease. Most often, the initial treatment of a perineal abscess is to drain it by inserting a loose seton. Recurrence is frequent after seton removal. Fistulotomy is usually contraindicated in patients with Crohn’s disease because fecal incontinence is a possible complication. Medical treatment frequently follows suppuration drainage. Anti-TNFα therapy has demonstrated its efficacy in randomized, controlled trials, and other immunosuppressants can also be administered.     

Incidences et causes d’insatisfaction des patients vis-à-vis de la prise en charge de la douleur postopératoire

Introduction

Patient satisfaction regarding postoperative pain management (POPM) is not always correlated with pain level relief.

Objective

To evaluate the percentage of satisfied patients while splitting satisfaction related with nurses, anaesthesiologists and surgeons during 48 h postoperative period.

Patients and methods

The study was performed in 2007 by two investigators in six different surgical suites in a university hospital. Approximatively 15 patients have been randomly selected in each surgical ward. Each patient received during the first or second postoperative day an anonymous questionnaire and was required to complete it with the investigator assistance if necessary. Questions requiring a yes-or-no reply assessed the patient's satisfaction with POPM performed by nurses, surgeons, and anaesthesiologists. In case of dissatisfaction, patients were invited to explain the reasons.

Results

Ninety-two patients were included, 5% of the patients were not satisfied with nurse POPM and nearly 15% were not satisfied with anaesthesiologist or surgeon POPM. The main reasons of dissatisfaction with nurses were the excessive delays between requesting and receiving an analgesic and because of the significant discrepancies in POPM between nurses. Patient discontent regarding surgeons was explained by the lack of interest of the latter for POPM. Patient discontent regarding anaesthesiologists was explained by the lack of anaesthesiologist visit in the postoperative period.

Conclusion

There is a relationship between patient dissatisfaction and the lack of attention for POPM by surgeons and the lack of postoperative visit by the anaesthesiologist. A postoperative visit by a team of anaesthesia nurses should improve patient satisfaction with POPM.     

Tumeurs de la main chez l’enfant

Soft-tissue and osseous tumors of the hand in children differ considerably from those of adults, not only in frequency but also in terms of anatomic distribution, histologic type and prognosis. Malignant tumors are rare in children, the most common being rhabdomyosarcoma for soft-tissue tumors, and osteosarcoma and Ewing sarcoma for osseous tumors. Hemangioma is the most common soft-tissue tumor in infancy and childhood. Other vascular abnormalities are capillary malformation, venous malformation. Many other benign soft-tissue and cutaneous tumors can be seen (ganglion cyst, naevus, fibroma…). The surgeon must know the signs, evolution and the treatment of these tumors.     

Prise en charge de la prééclampsie dans un réseau de périnatalité

At community level, the perinatal management can be summarized as follows: