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1.
E. Laurent A. Lemaignen G. Gras J. Druon K. Fèvre P. Abgueguen G. Le Moal E. Stindel A.-S. Domelier S. Touchais C. Arvieux L. Bernard P. Rosset L. Grammatico-Guillon 《Revue d'épidémiologie et de santé publique》2019,67(3):149-154
Background
In France, the most severe bone and joint infections (BJI), called “complex” (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification.Methods
Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients.Results
Inter-expert agreement during one MTM was moderate (κ = 0.49), and fair (κ = 0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ = 0.50, range 0.27–0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ = 0.58), it was better between MTMs with professor (κ = 0.65) than without (κ = 0.51) and with longer median time per case (κ = 0.60) than shorter (κ = 0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ = 0.40).Conclusion
The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM. 相似文献2.
Savoye G Leroi AM Bertot-Sassigneux P Touchais JY Devroede G Denis P 《Scandinavian journal of gastroenterology》2002,37(12):1411-1416
BACKGROUND: The purpose of this study was to compare the manometric assessment of straining effort as if to defecate and rectoanal inhibitory reflex obtained with a rectosphincteric balloon probe and with a water-perfused catheter in the same subject. METHODS: Twelve healthy volunteers underwent two manometric assessments of anal sphincter function and electromyographic (EMG) surface recordings. one with a rectosphincteric balloon and one with a water-perfused catheter, 7 days apart in random order. RESULTS: Increased EMG activity in the external anal sphincter in the midst of the rectoanal inhibitory reflex (P < 0.001) and during straining for defecation (P < 0.001) was more frequently observed with the perfused system than with the balloon probe. There was a discrepancy between the EMG activity of the external anal sphincter and the anal pressures during straining recorded with the perfused system. Duration of the reflex elicited by rectal distension with 10 and 20 ml of air was significantly greater with the rectosphincteric balloon than with the perfused catheter (P = 0.02 and P = 0.05, respectively). CONCLUSION: Water instilled in the anal canal by the perfused system induces artifacts in EMG recording and active anal contractions. These artifacts and induced contractions could lead to an erroneous diagnosis of anismus, particularly if pelvic floor EMG is only taken into account for the diagnosis of anismus. 相似文献
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Aubin GG Bémer P Guillouzouic A Crémet L Touchais S Fraquet N Boutoille D Reynaud A Lepelletier D Corvec S 《Journal of clinical microbiology》2011,49(5):2074-2076
We describe the first case of hip prosthetic infection due to Lactococcus garvieae. The patient, a 71-year-old woman fishmonger, developed a hip infection 7 years after total hip arthroplasty. The origin of infection was possibly due to the manipulation or intake of seafood or fish contaminated with Lactococcus garvieae. 相似文献
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P Hochain P Ducrotté B Paillot J Y Touchais J M Thorel A Petit D Ouvry P Hecketsweiler 《Gastroentérologie clinique et biologique》1992,16(6-7):552-557
Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible. 相似文献
6.
Dr. Anne-Marie Leroi M.D. Marie-Paule Dorival Marie-Françoise Lecouturier Christine Saiter Marie-Laure Welter M.D. Jean-Yves Touchais M.D. Philippe Denis Ph.D. 《Diseases of the colon and rectum》1999,42(6):762-769
PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29–74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.Presented at the XXIst congress of the Societé Internationale Francophone d'Urodynamique, Lisbon, Portugal, May 14 to 16, 1998. 相似文献
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Analysis of different factors affecting results of the surgical treatment of gastroesophageal reflux
J Y Touchais E Lerebours F Sauger J Testart P Ténière P Ducrotte J F Guillard D Paley J P Galmiche P Denis 《Gastroentérologie clinique et biologique》1985,9(10):712-718
Gastric emptying, gastric secretion and esophageal pH were studied prospectively in 32 patients who had either a Lortat-Jacob type operation (n = 7) or a fundoplication with a 360 degrees (n = 4), 270 degrees (n = 5) or 180 degrees (n = 16) gastric fundic wrap. The goal was to determine the effects of various antireflux mechanisms on these functions as well as to try to explain abnormal postoperative esophageal pH scoring indexes. Esophageal pH was recorded during the 3 h period following a standard meal. Acid reflux was expressed using a scoring index taking into account the duration and magnitude of pH fall. Preoperatively, all patients had an abnormal pH scoring index. Postoperatively, the pH scoring index remained increased in 7 patients (group A) and returned to normal values in 25 (group B). Clinical data, esophageal pH parameters and gastric acid secretion measured preoperatively were not significantly different in the two groups of patients. Preoperative gastric emptying for liquids was shorter in group A than in group B patients (p less than 0.05). Postoperative gastric emptying of radiopaque markers was not different in the two groups of patients. Postoperative resting pressure of the lower esophageal sphincter was always less than 10 cm H2O in group A and more than 10 cm H2O in group B patients. Changes in lower esophageal pressure after surgery were higher in group B than in group A patients (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
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