Efficacit�� et s��curit�� de la sleeve gastrectomie chez les super-superob��ses

Aim

To assess the efficacy of laparoscopic sleeve gastrectomy for super-superobesity in 30 patients (BMI > 60 kg/m²).

Methods

This prospective study has analyzed the duration of surgery, length of hospital stay, post-operative complications, percentage of excess weight loss and need for a second surgery (re-sleeve gastrectomy or gastric bypass) in case of insufficient weight loss. Twenty-three women and 7 men were included, with a mean age of 35 years (18?C59), mean pre-operative BMI of 66 kg/m² (60?C85) and mean weight of 168 kg (140?C258). The study included one patient with complete situs inversus and 4 (14%) patients with a previous restrictive bariatric surgery.

Results

The mean duration of surgery was 120 minutes (80?C220). The mean hospital stay was 7.5 days (4?C28). There was no post-operative mortality. Laparotomy was not needed. There were 4 complications: sub-phrenic haematoma (2), gastric fistula (1) and pulmonary embolism (1). Out of the 23 patients who were followed up for 18 months, 17 (77%) patients achieved sufficient weight loss, whereas 6 (23%) patients showed insufficient weight loss, leading to re-sleeve gastrectomy (in 3 cases) or gastric bypass (in 2 cases), and one patient refused another surgery. Three years after the initial sleeve gastrectomy, the mean weight loss was 56 kg (28?C144), the mean percentage of excess weight loss was 51% (28?C82) and the mean loss of BMI was 20 kg/m² (10?C39).

Conclusion

These results show that laparoscopic sleeve gastrectomy can be performed safely, with few post-operative complications and is efficient in treating super-superobese patients. It can be either a stand-alone procedure if the results are good or a first-stage procedure before a re-sleeve or a gastric bypass if long-term results are insufficient.     

Int��r��t et place du renforcement musculaire isocin��tique dans le traitement de la gonarthrose

Objective

To define isokinetic muscle strenghtening in knee osteoarthritis rehabilitation.

Methods

A systematic literature review on Pubmed, Cochrane Library, Reedoc and Pedro databases, Geni and Cofemer websites, using isokinetic and knee osteoarthritis key words was done. Only randomized controlled trials were retained.

Results

Eight randomised controlled trials have been selected. Isokinetic exercice provides greater effectiveness than control, but its effect is comparable to other muscle strengthening techniques. Integrated therapy also shows substantial benefit.

Conclusions

Isokinetic muscle strenghtening can be usefull to take in charge knee osteoarthritis. Further high quality studies should help to confirm the effectiveness of isokinetic exercice and better determine its role in knee osteoarthritis management.     

Mode d’emploi du ginseng et d’autres adaptogènes*

Sans résumé     

Douleurs provoqu��es par les soins dispens��s �� la personne souffrant de d��mence de type Alzheimer : pour une organisation questionn��e des soins

We address the present knowledge on pain induced by measures used in patient care. This is an attempt to develop a team approach to the prevention of this problem (irrespective of whether the patient does or does not have cognitive difficulties). We deal with the following topics sequentially: 1) the essential basic definitions; 2) the principles guiding the production of an individualised care plan; 3) the key elements to be examined before arranging the care, carrying it out and continuing it in the longer term; 4) the choice of which measures should be employed in relation to scientific advances and work patterns.     

Impact de la chirurgie bariatrique sur la fertilit�� et les complications maternof?tales: ��tude pilote r��trospective sur le registre ob��sit�� de la Soffco

Obesity has a negative impact on female fertility. Obesity also increases the risk of obstetrical maternal and fetal complications. Although bariatric surgery has been shown to fix comorbidities and mortality, its consequences on fertility and fetomaternal complications are still controversial. The impact of bariatric surgery was studied in 191 women of reproductive age (18 to 40 years) who benefited from bariatric surgery. Our results confirm a significant weight loss with an improvement of comorbidities after bariatric surgery and a decrease of menstrual cycle irregularities. However, the results don??t demonstrate a decrease of miscarriages rate and pregnancy or maternal complications.     

L����valuation exp��rimentale de la douleur dans la d��pression majeure

The relationship between major depressive disorder (MDD) and pain is more complex than originally thought. MDD is frequently accompanied by somatic pain symptoms and is a risk factor for chronic pain. Paradoxically, most experimental studies on pain perception in MDD have described hypoalgesic responses in patients. This literature review aims to evaluate the empirical findings and identify the factors contributing to heterogeneity of results.     

Estimation de la consommation pic d��oxyg��ne par la perception de l��effort chez des patients ob��ses et diab��tiques de type 2

Objectives

The main objectives of this study were: 1) to assess the validity of predicting peak oxygen uptake (.VO₂peak) from ratings of perceived exertion (RPE) during a sub-maximal graded exercise test (GXT), in obese patients with diabetes, and 2) to compare the accuracy of predictions obtained from RPE ?? 15 and RPE ?? 17. Materials and methods: Seventeen obese women with type 2 diabetes performed GXT to volitional exhaustion, in which oxygen uptake (.VO₂) and RPE were measured. Individual linear regressions between.VO₂ and RPE, that were collected during the first stages of GXT (RPE ?? 15 and RPE ?? 17), were extrapolated to RPE = 20 in order to predict.VO₂peak. Results: Actual (12.7 ± 3.6 ml.min^?1.kg^?1) and predicted.VO₂peak from RPE ?? 15 and RPE ?? 17 (13.1 ± 3.7 and 13.3 ± 3.8 ml.min^?1.kg^?1, respectively) were not significantly different. The actual.V O₂peak were significantly correlated to the predicted.VO₂peak from RPE ?? 15 and RPE ?? 17 (R = 0.89 and R = 0.92, respectively). The 95% limits of agreement analysis were ?0.4 ± 3.4 and ?0.6 ± 3.0 ml.min^?1.kg^?1 for the predictions from RPE ?? 15 and RPE ?? 17, respectively.

Conclusion

Results suggested that the RPE ?? 15 provide accurate.V O₂peak prediction in obese women with type 2 diabetes. However, the accurate of predictions was improved when the.VO₂peak was predicted from RPE ?? 17. Consequently, RPE may be used to predict.VO₂peak and to decrease the risk of cardio-vascular complications during GXT.     

Outil d’aide à la décision et à la prévention dans les sports collectifs. Exemple d’un centre de formation rugby

Introduction

Monitoring training load is a key factor in the optimization of the training process, whether it is to enhance performances or to reduce the risk of injury.

Apport de l��analyse quantifi��e de la marche (AQM) dans la compr��hension des m��canismes responsables des troubles de la marche des patients h��mipl��giques et dans l����valuation des effets des diff��rents traitements classiquement utilis��s

Three-dimensional motion analysis uses optoelectronic systems that enable the simultaneous gathering of kinematic (degree of movement of the different joints), kinetic (restrictions on the different joints) and electromyographic (muscular activity) data during movements in the three planes of 3D space. These tools, initially used for 3D animation films and video games, are appearing more and more in the clinical domain. For many years, it has been the reference examination to better understand the movements of patients presenting with central nervous system (CNS) lesions. Three-dimensional motion analysis has, in particular, allowed: 1) the quantification of previously recognised anomalies; 2) a better understanding of the different mechanisms that could be at the centre of a loss in hip, knee or ankle flexion whilst walking, for patients presenting with a CNS lesion; 3) the study of parameters previously inaccessible, such as the coordination or variation in muscle length during a movement; 4) a better definition of the effects of different traditional treatments used to improve the walking for these patients, regardless of its nature (physiotherapy, pharmacological, surgical, etc.). The aim of this article is to present the key results obtained from this tool, and to demonstrate the contribution this tool has made in the diagnostic and therapeutic management of walking problems of hemiplegic patients.