Postpartum-urinary retention. A report of two cases and a review of literature

The urinary retention is rather banal during the postpartum: 0.45 to 17.9% and now we know the main risk factors: duration of labour, epidural, episiotomy. Diagnosed on time, the postpartum-urinary retention will not have any consequence; on the other hand, a delay in care can lead to a persisting urinary retention with possible long-term urinary sequels. This article, based on two cases reports and a literature review, shows the heterogeneity in medical care of the postpartum-urinary retention.     

L'œdème aigu du poumon chez des patientes en menace d'accouchement prématuré traitées par inhibiteurs calciques : place de facteurs prédisposants ou pharmacologiques spécifiques ?

Calcium channel blockers of the dihydropyridin's family have been associated with the onset of an acute pulmonary edema when they are used as a treatment of preterm labor. We report here four cases of pulmonary edema in pregnant women treated with nicardipine (Loxen) for preterm labor. The physiopathology of pulmonary edema, the pharmacology of calcium channel blockers of dihydropyridin's family and the detailed analysis of our cases and those of the literature make us discuss of the role of these agents and associated population and risk factors in such complication.     

Liver rupture in peripartum: about 8 cases

Objectives

Subcapsular liver hematoma (SLH) is a serious complication of the preeclampsia and HELLP syndrom. We report eight cases, and we'll precise circumstances of occurrence of this complication, its management and its prognosis.

Materials and methods

Between January 2000 and December 2005, we enrolled eight patients with SLH cases in the intensive care unit of maternity's Ibn Rochd university hospital in Casablanca, Morocco.

Results

The patients are 22 to 41-years-old; six are multiparous, without prenatal care. All are preeclamptic. We diagnosed the SLH in prepartum stage in one case, in operating room in five cases and in post partum stage in two cases. We established blood pressure and homeostasis disturbances, the surgeon made packing for six patients with hepatic artery ligature in two cases. In two other patients, we did only medical care. We noted five deaths, four after hematoma rupture.

Conclusion

These results were compared with literature, we need to look for this complication in all-severe preeclampsia with HELLP syndrome, and treat all haemostatic disorders.     

Suivi des témpératures dans des préparations lactées en néonatalogie : potentiels de croissance de Enterobacter sakazakii

The purpose of this study was to evaluate the temperature conditions in neonate care units for infant milk formula (IMF) preparation, storage and neonate feeding by oral and enteral nutrition. From IMF preparation until first and last neonate feeding period per 24 h, 179 time-temperature profiles of IMF samples were collected in 25 neonatal care units in 15 hospitals. Results showed Afssa specifications on temperatures were not completely observed: blast chiller missing and important delay for cooling down IMF to 4 ?C, ineffective or incorrectly regulated cold cabinet cold cabinet for keeping IMF at 4 ?C, microwave or water batch used for rethermalizing IMF.In order to show the health impact of this data, potential Enterobacter sakazakii growth was calculated. For bottles, potential E. sakazakii growth increments were under 2 log₁₀ due to short (≤24 h) cold storage duration. Nevertheless good hygiene practices have to be respected for reducing a particularly high danger for neonates. Afssa specifications are the minimum to observe. For continuous feeding syringe, potential growth values were mainly due to the feeding period because of the IMF was kept in the infant's room at room temperature (≈ 25 ?C) during a long time. In these conditions microbial growth is difficult to control. Nevertheless the use of a cold cover for keeping the IMF at low temperature in a continuous feeding syringe could ensure good food safety.     

Comorbidité des troubles anxieux avec l’alcoolisme

Alcohol dependence entrains psychological, physiological and toxic factors. Anxiety, depression and other emotional disorders may be a cause or a consequence of alcohol dependence. Although alcohol is known to have anxiolytic and anti-phobic properties, alcoholic patients have a higher prevalence of developing anxiety disorders. A prevalence of panic disorders is higher in an alcoholic population and similarly alcohol dependence is higher in a population suffering from panic disorders. The association of alcohol dependence with depression in panic disorders increases suicidal risks and ideation. The prevalence of alcohol dependence is also higher in phobias and OCD. Alcohol dependence and anxiety disorders seem to be genetically associated: Anxiety disorders are greater in first degree family members of alcoholic patients. Alcohol dependence can be a cause or a consequence of anxiety disorders; simple, social phobias and agoraphobias usually precede alcoholism, while GAD occurs simultaneously with it. Depending on dose intake alcohol can reduce or increase anxiety by causing a dysfunction of the neurotransmission of GABA, glutamate and noradrenalin receptors. Alcohol intake can have euphoric or depressive effects, depending on dose intake, psychological characteristics and patients’ expectations.     

La pratique des entretiens préliminaires de psychothérapie psychanalytique: Critères d’évaluation - Étude quantitative

The practice of preliminary interviews is a field that researchers have little looked into until today. However, it is during those very first sessions between “the analyst and the analyzed” that is born the possibility of working out a psychoanalysis. This study deals with the practice of preliminary interviews in psychoanalytical therapies, based on the results of an empirical research that was carried out at the Pitié-Salpêtrière University Hospital and involved 30 therapists. The data for this study were collected, thanks to the therapists’ answers to a validated, standardized 36 items-questionnaire regarding what they could “hear” during the first sessions with their patients. The questionnaire was completed by 15 therapists with at least 10 years’ experience and 15 therapists with less than 5 years’ experience, and they answered regarding a patient they had seen two to five times. It covers five variables chosen according to their degree of involvement in their decision to follow that patient. An evaluation scoring sheet allows the psychoanalyst group to score the session, which has been tape-recorded. The results of the evaluation scoring sheet are the “objective” aspect of the study. The five questions regarding the five variables allow the therapists to evaluate whether or not they feel they have answered the questionnaire. Their own assessment of their clinical work is the “subjective” aspect of the study. The study focuses on the therapists’ mental work during the initial phase of the treatment: on what basis is the decision to follow a patient made? How important is the patient’s meta-communication skills at the beginning of the treatment and what do they mean to the therapist? Does it account differently for more or less experienced therapists? And what can we say about the analysts’ objectivity (the practice itself) and subjectivity (their feelings about the practice)? The data of our study show that, for all the therapists involved, the patient’s ability to meta-communicate matters very much to psychoanalyst. A comparative study allows us to account for the gaps or the overlapping between the objective and subjective aspects in both therapist groups. Finally, we noted that therapists with at least 10 years’ experience and therapists with less than 5 years’ experience functioned differently.     

Approche neurobiologique des traits tempéramentaux associés aux troubles de personnalité

Recent publications in the field of neurobiology related to personality disorders allow some consideration on the bidirectional relationship between genetically determined temperamental traits and environment, interactions observed in the normal development of personality during childhood and adolescence or on the contrary in the building of a disordered personality revealed at adulthood. Based on the review of studies about development of personality disorders in children, adolescents and adults, this article puts forward the interactive quality of relations between genetic background and environmental factors and proposes hypotheses concerning the role of temperament in the development of personality. Correlations between genes and environment (rGE) and interactions gene-environment (GxE) are examined. Bidirectional feedback between temperament and environment where individual temperamental characteristics determine environment selection or adjustment and not the opposite is an example of an interaction of evocative type. However, actual research designs face difficulties in the establishment of a causal link due to the multitude and complexity of involved factors linking personality traits with temperamental genetic markers. This might explain the emergence of an endophenotype concept as it has been used with autism. An endophenotype consists in a mesurable cognitive, neurophysiological or neurochemical variable expressing the genetic defect present before the onset of the illness. Some studies put forward possible endophenotypes for borderline, antisocial and schizotypal personality disorders. Longitudinal research has shown the predictive quality of externalized conduct disorders of childhood leading to antisocial and to a lesser extent borderline personality disorders in adulthood. Impulsivity and affective lability might be based on minor neurocognitive abnormalities, subclinical attention deficits and/or marked neuropsychological dimensions such as strong extraversion. Suboptimal serotoninergic regulation has been established in destructive impulsivity and suicidability. Abnormalities in the dopaminergic and noradrenergic systems might also be implicated but it remains unclear to what extent repeated trauma and abuse during childhood might modify the hypothalamic-pituitary-corticotropic axis in response to chronic stress and transform permanently the modulation of physiological and psychological reactions of these children to their perturbed environment. Researches on conduct disorders have also demonstrated the evocative interaction of a particular temperament with the environment responding to marked novelty seeking behaviour, hyperactivity, impulsivity and lack of proper physiological reaction to extreme stimuli. Lack of behaviour inhibition found in antisocial individuals is attributed to noradrenergic and serotoninergic abnormalities and neurocognitive deficits. The dimensional continuity of schizotypal personality to schizophrenia is well established and electrophysiological markers such as abnormal eye tracking movements, P300 evoked potentials, prolonged electrodermal reactions with cognitive disorganization and deficits in inhibition of attention to usual stimuli might be the future endophenotypical markers to schizophrenia susceptibility. Further studies on temperamental traits might lead to the identification of genetic markers as precursors to personality disorders.     

Intervention précoce en autisme : un défi pour les praticiens

When the three main characteristics of autism (i.e. a qualitative alteration in reciprocal social relations; in verbal and non-verbal communication; resistance to change) are considered, it can be seen that the child with autism derives little satisfaction from the social and communicational interactions that form part of his everyday life. Moreover, he experiences a great deal of difficulty in adapting to the numerous changes of location, activity, and persons that he meets during the day — all of which he might possibly wish to remain unchanged, or uniform. Autism therefore presents a considerable challenge to therapists who are preoccupied with improving the quality of life in the very young child with autism, and with the early intervention strategies that could be implemented. On the basis of the most recent studies in the field of behavioral science, the characteristics of efficient early intervention include the following: early intervention and initiation of treatment; intensity of treatment; involvement of the child’s parents in the ongoing collaborative project; the necessity of taking into account the various daily environments to which the child is exposed; the introduction of individualized intervention programs; and finally, taking into consideration the biomedical aspect together with an educational-developmental approach. The implementation of an early intervention approach including the above-mentioned characteristics poses a major challenge to practitioner both as regards the evaluation of these children with autism, and also the implementation of the treatment program.     

Le diagnostic précoce des troubles autistiques de l’enfant en pratique

The work of the Unit for screening and assessment of early developmental disorders of Caen University Hospital aims at detecting all the autistic children in an administrative area as early as possible. The ambition would be to diagnose autistic syndromes before the age of two and a half, so that early treatment may benefit autistic children. The Unit activity is built around young children and their families in collaboration with professionals. Using standard and internationally accepted means for screening, diagnosis and assessment brings a maximum objectivity and allows comparisons. In addition to its task of diagnosing and assessing developmental disorders, the Unit is permanently concerned with training and research. Supplying information and training concerned professionals is a fundamental in improving early screening. As for research, it is to be carried out without any aetiological a priori and with the aim of clarifying the risk factors of infantile autism.     

L'image du corps en neurologie : de la cénesthésie à l'image spéculaire. Apports cliniques et théoriques de la psychanalyse

In neurology, the terms body schema and body image currently refer to two different body representations. These representations are meant to allow humans individuals to automatically adjust their bodies to space in sensorimotor activities and also have a semantic knowledge of their bodies and their body-space relationships. The term body image is also used in psychoanalysis, in a quite different maner. From the psychoanalytical point of view, body image is one of the registers of identity and the Other’s regard plays a primordial role in the subject's acquisition of this identity. The crucial role of this gaze appears in the term specular image. After reminding the reader of history and the predecessors of these terms, we consider the implications of the concept of specular image in neurology. We show that neurological pathology may have effects upon specular image, up to and including a disorganization of the structure of specular image when brain lesions affect body schema. This perspective permits to find out a coherence and a logic in some psychiatric-like symptoms of right hemispheric brain lesions.