Risque et existence : un éclairage du risque thérapeutique en psychiatrie

Risk management is a principle of political action, an organisational strength that keeps increasing in our modern societies. In medicine, the benefit/risk ratio precedes any therapeutic treatment. Psychiatry also confirms this trend. It is undoubtedly desirable in many aspects. However, the notion of risk cannot be understood under the unique and technical perspective of an undesirable event to anticipate. Risk management is not limited to a predictive and preventive refinement, but disturbs the situation of the individual in its environment, granting him a new responsibility, changing his possibility to live in the world and take shelter in it. Beyond these anthropological aspects, from a phenomenological psychiatry perspective, the matter of risk is closely related to the question of authentic existence. Thus, the risk not only appears under the perspective of an undesirable event, but also as a founding instant of the existence in the world and within oneself. Therefore, the therapeutic project of psychiatry could also intend to recognize and promote a certain type of risk, the risk of any existential commitment. The therapeutic risk in psychiatry thus takes a new ontological dimension.     

Non-ossifying fibroma,fibrous cortical defect and Jaffe–Campanacci syndrome: a biologic and clinical review

Non-ossifying fibroma of bone (NOF) is a common entity, more frequently found in male children and consisting of a solitary eccentric, lytic expanded lesion in the metaphysis of a long bone. The disorder is benign and most often asymptomatic but may result in a fracture requiring therapy. Of some importance is to distinguish NOF from another very similar but smaller lesion, fibrous cortical defect, which is almost always asymptomatic and eccentrically located. Even more striking is a very rarely encountered lesion known as Jaffe–Campanacci syndrome, which also occurs in children who present with typical non-ossifying fibromatous tumors but in multiple sites. In addition, these patients have some systemic and dermal findings resembling those seen in patients with Type 1 neurofibromatosis.     

Improved Postoperative Pain Control using Thoracic Paravertebral Block for Breast Operations

Abstract:  Thoracic paravertebral block (PVB) in breast surgery can provide regional anesthesia during and after surgery with the potential advantage of decreasing postoperative pain. We report our institutional experience with PVB over the initial 8 months of use. All patients undergoing breast operations at the ambulatory care building from September 09, 2005 to June 28, 2005 were reviewed. Comparison was performed between patients receiving PVB and those who did not. Pain scores were assessed immediately, 4 hours, 8 hours and the morning after surgery. 178 patients received PVB and 135 patients did not. Patients were subdivided into three groups: Group A–segmental mastectomy only ( n  = 89), Group B–segmental mastectomy and sentinel node surgery ( n  = 111) and Group C–more extensive breast surgery ( n  = 113). Immediately after surgery there was a statistically significant difference in the number of patients reporting pain between PVB patients and those without PVB. At all time points up until the morning after surgery PVB patients were significantly less likely to report pain than controls. Patients in Group C who received PVB were significantly less likely to require overnight stay. The average immediate pain scores were significantly lower in PVB patients than controls in both Group B and Group C and approached significance in Group A. PVB in breast surgical patients provided improved postoperative pain control. Pain relief was improved immediately postoperatively and this effect continued to the next day after surgery. PVB significantly decreased the proportion of patients that required overnight hospitalization after major breast operations and therefore may decrease cost associated with breast surgery.     

Regression of intracranial meningioma following intratumoral hemorrhage

An intratumoral hemorrhage within a meningioma occurs infrequently; in less than 3% of all lesions. When hemorrhage does occur, however, it is associated with a poor prognosis and significant mortality rates. We report a 66-year-old woman with a 10-year history of multiple intracranial meningiomas managed conservatively who underwent surgical resection of a spheno-orbital lesion for decompression of the right optic nerve. Postoperatively, an intratumoral hemorrhage developed in a contralateral lesion, which was managed conservatively. During follow up, the hemorrhaged lesion became significantly smaller. To our knowledge there are no published reports of spontaneous resolution of a meningioma after intratumoral hemorrhage without surgical management. We review the literature on hemorrhage in meningiomas and postulate some pathophysiologic mechanisms for the bleeding and subsequent tumor resolution seen in this patient.