Fermeture percutanée des communications interventriculaires congénitales par la prothèse Amplatzer Duct OccluderII: données préliminaire d’une étude Tunisienne monocentrique

Introduction . Percutaneous closure of congenital ventricular septal defects (VSDs) represents a promising alternative to surgery with lower rate of complications and shorter hospital stay. Its main limitation is the choice of the appropriate device for each type of defect. Aim. To report the experience of the service of cardiology (Sahloul hospital, Sousse, Tunisia) in percutaneous closure of congenital VSDs with Amplatzer Duct Occluder II (ADOII). Methods. This was a retrospective, monocentric study, conducted from January 2013 to December 2017. The study included patients treated by percutaneous closure of congenital VSDs with the ADOII device. Results. Twelve patients (6 boys; 6 girls) were included. The mean±SD of patients’ age and weight were 65±41 months and 23±10 kg, respectively. VSDs were peri-membranous (n=9) and muscular (n=3), and defects were restrictive (n=11) and non-restrictive (n=1). The mean (minimum-maximum) size of VSDs was 4.72 (3-6) mm. Eleven ADOII prostheses were successfully implanted. One failure procedure was noted with migration of the device into the pulmonary artery. A second child with perimembranous defect developed transient atrioventricular block. No deaths occurred. Conclusion. The present early experience shows that percutaneous closure with ADOII device of perimembranous and trabecular VSDs is safe and effective.     

Prognostic Analysis of Spinal Metastasis Secondary to Lung Cancer after Surgeries: A Unicentric,Large‐Cohort,Retrospective Study

Purpose Spinal metastases of lung cancer (SMLC) usually have high degree of malignancy and require surgical treatment. However, there are several controversies about the efficacy of surgery. This study aimed to investigate factors predicting prognosis of SMLC after surgery‐based comprehensive treatment.MethodsA cohort of 112 cases of SMLC who underwent surgical treatment between 2009 and 2020 were retrospectively reviewed and analyzed. The surgical strategies included total en‐bloc spondylectomy, debulking surgery, palliative decompression, and vertebral augmentation procedures. The patients were regularly followed‐up. Survival analysis was performed, as well as analysis of the patients'' neurological recovery, pain relief, and improvement of Karnosky performance score (KPS). Cox regression was used to analyze influencing factors of survival time, and Kaplan–Meier method was performed in survival analysis.ResultsThe cohort included 63 males and 49 females, with an average age of 60.6 ± 10.6 years. Median survival time was 16 months. A total of 86.7% of paralysis patients'' neurological function recovered and 83.9% of patients with low KPS score (10–40) improved. Surgical method was significantly correlated with improvement of neurological function (p < 0.001) and KPS (p < 0.001). The mean bleeding volume was 502 ml and operative time was 170 min. The survival rates at 3, 6, 12, 24, and 36 months were 92.0%, 80.4%, 63.4%, 63.4%, and 22.6%, respectively. Postoperative Frankel grade (p < 0.001), postoperative KPS score (p = 0.001), and application of molecular targeted drugs (p < 0.001) were significantly correlated with survival time in univariate analysis, while application of molecular targeted drugs was an independent predictor for a longer survival by a multivariate analysis.ConclusionSurgery‐based comprehensive treatment brought a fair outcome, with elongated survival time. Surgery can significantly improve patients'' neurological function and physical performance status. Adjuvant targeted therapy is an independent positive factor for patients'' survival.     

CT血管造影在评价冠状动脉支架术后支架内再狭窄中的价值

目的研究CT血管造影(CTA)在评价冠状动脉支架术后支架内再狭窄中的应用价值。方法40例冠状动脉支架术后患者(共82枚支架),分别接受16排CTA和常规冠状动脉造影(CAG)检查,并由两位有经验的医师独立对冠状动脉支架开通或再狭窄进行评估。结果CTA方法能评价所有82枚支架中的68枚(83%),其中支架直径≥3.0 mm者53枚(78%),支架壁厚度<140μm者51枚(75%);CAG显示有7枚支架发生再狭窄,CTA发现其中5枚;CAG和CTA对其余61枚支架均显示无再狭窄。在CTA不可评价的14枚支架中,支架直径<3.0 mm者13枚(93%),支架壁厚度≥140μm者13枚(93%)。CTA对冠状动脉支架术后再狭窄诊断的敏感性、特异性、阳性预测值和阴性预测值分别为71%、100%、97%和100%。结论16排CTA能较准确地评价冠状动脉支架术后支架内再狭窄的发生,尤其对大直径、薄金属壁支架的评估价值较高。     

A case study about the use of the prospective strategy in the scenarization of a pedagogical workshop

IntroductionPedagogical workshop planning is challenging especially when we aim to promote a reflective practice of the tutees. This practice has been widely discussed in the literature without a real consensus. Some authors reported oral exercises or anecdotes, other described writings or even storytelling. The aim of the authors was to describe the different steps performed by the tutors and to assess the tutees’ satisfaction.Material and methodsThis was a pilot study dealing with the use of the prospective strategy principles in order to plan a pedagogical workshop. Included participants were early academic teacher trainees.ResultsThe authors illustrated how they planned a pedagogical workshop using the prospective strategy and highlighted the satisfaction of the tutees.ConclusionProspective strategy is mainly used in economic field in order to change the future of the companies by acting on different intervening factors. Associating prospective strategy to pedagogical principles hasn’t been reported in the medical literature and seems to be available in order to induce reflective practice.     

肿瘤学实践技能改善活动:提高肿瘤学医师的诊疗水平

美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)是全球领先的肿瘤专业学术组织,学会宗旨是预防癌症及改善癌症诊疗服务.肿瘤学实践技能改善活动(Quality Oncology Practice Initiative,QOPI)始于2002年,是在ASCO健康服务委员会的指导下,以临床实践为基础的医疗质量改善活动,其目标是帮助肿瘤科医师通过自我检查和改善,促进其诊疗水平的提高.     

Hospitalization for Early Bonding of the Genetic Mother After a Surrogate Pregnancy: Report of Two Cases

Background: In surrogate pregnancies the genetic parents have little opportunity for early bonding to their infant, either prenatally (in utero) or in the immediate postnatal period. The purpose of this article is to describe a new method for encouraging early parent‐infant bonding after surrogate pregnancy by hospitalizing the genetic mother in the maternity ward immediately after the delivery. Methods: Two genetic mothers were hospitalized in the maternity ward (rooming‐in system) at the Rabin Medical Center in Israel immediately after delivery of their infants by surrogate arrangement. The first birth was a singleton pregnancy with vaginal delivery and the second, a twin pregnancy with delivery by cesarean section. The genetic parents were counseled by a social worker from the adoption agency, starting 3 months before the estimated date of delivery. The parents were referred to the hospital social worker before the delivery. To assess attachment, we observed the parents' behavior toward their children during two daily 15‐minute periods of free, unstructured interaction. Results: The parents showed good primary caregiving functions and established affective verbal and physical contact with the infants. They began to recognize the infants' needs and temperament, and exhibited an aura of self‐confidence during their interactions. All expressed satisfaction with the method at discharge and reported on reduction of their fears about returning home with the infants. Conclusions: We believe that early hospitalization of the genetic mother in a surrogate delivery may be desirable to establish good and safe early mother‐infant bonding, and that it should be considered for adoption as regular hospital policy. Further randomized studies with larger samples over the long term are warranted.     

Terminal cardiac mechanism in coronary artery disease: Report of two cases

A case is reported in which ventricular tachycardia was followed by cardiac standstill; the cause of death was coronary artery disease. This is in support of the contention of Grieco and Schwartz that cardiac standstill should occur as frequently as ventricular fibrillation, and that, if more records could be obtained, additional instances of cardiac standstill would probably be discovered.A second case, in which ventricular fibrillation occurred during the period of terminal cardiac activity, is added to the five such cases which have been previously reported by others.