Search

The propagation of a wave in a medium is generally affected when the medium is moving with respect to the observer. Because plasma equilibria often involve plasma flows, for instance in astrophysics or in magnetic confinement nuclear fusion devices, understanding the effect of motion on plasma waves is important. Meanwhile, the presence of a background magnetic field in a plasma makes it anisotropic. To address this problem, we derive here ray tracing equations for the trajectory of rays propagating in a moving anisotropic medium. The proposed approach is to use an effective dispersion relation for the moving medium as seen from the laboratory, obtained by performing a Lorentz transformation of the dispersion relation known for the medium at rest. This formalism is illustrated by considering the low frequency Alfvén waves and the standard ordinary and extraordinary modes in a magnetized plasma at rest.

Introduction Le rôle du pharmacien est de dispenser les antirétroviraux (ARV) de façon optimale dans un souci de vigilance concernant le dépistage et la gestion des interactions médicamenteuses et des effets indésirables, le bon usage et l’observance maximale du traitement par le patient. Aussi, nous avons voulu connaître les habitudes et les attentes des personnes vivant avec le VIH (PVVIH) vis-à-vis de leur pharmacien dans le contexte de la dispensation mensuelle des ARV et des consultations hospitalières semestrielles. Matériels et méthodes Enquête nationale durant la semaine du 12 au 18 octobre 2016 dans tous les centres participants recrutés par les COREVIH, les URPS, syndicats de pharmaciens et maîtres de stages en pharmacie. Résultats Parmi les 1213 PVVIH vues en consultation ou en dispensation, 1137 ont participé à l’enquête (taux de participation de 94 %) : 775 (68 %) étaient des hommes, d’âge 50,2 ± 11,5 ans, ayant un nombre de CD4 à 671 ± 354 et 89 % une charge virale VIH (CV) indétectable. Au total 724 (64,2 %) PVVIH ont déclaré d’autres troubles que le VIH. L’analyse des correspondances multiples effectuée sur les caractéristiques démographiques et médicales des 635 PVVIH ayant rempli tous les items révèle trois clusters de personnes : celles qui, en dehors du VIH, n’ont pas de problème de santé, celles qui présentent des comorbidités en particulier métaboliques et/ou cardiovasculaires, et celles qui se disent anxieuses. La dispensation des ARV s’effectue en pharmacie d’officine pour 810 (72 %) PVVIH, majoritairement hommes (OR homme versus femme : 1,6[1,04–2,5]), anxieux (OR anxiété versus non : 2,2[1,2–4,04]), et travaillant moins souvent (OR travail versus sans : 0,56[0,36–0,87]). Le dossier pharmaceutique (DP) a été proposé à 120/694 (17,3 %) PVVIH et 96 (80 %) l’ont accepté. Si aujourd’hui 78 (7 %) PVVIH se sentent bien prises en charge car on leur propose un entretien pharmaceutique, 343/1078 (32 %) le souhaiteraient, majoritairement celles qui ont une durée d’ARV moins longue (OR durée ARV : 0,97[0,95–0,99]), une charge virale moins souvent indétectable (OR CV indétectable versus non : 0,55[0,30–0,98]) et plus souvent anxieuses (OR anxiété versus non : 2,38[1,47–3,83]). Conclusion Parmi les personnes recrutées, représentatives de la population PVVIH en France, la dispensation en officine est largement répandue, mais le DP est peu proposé alors qu’il semble être bien accepté- et indispensable. Environ 30 % des PVVIH souhaiteraient bénéficier d’entretiens pharmaceutiques. Le miroir de cette enquête en cours de réalisation auprès des pharmaciens sera également présenté, permettant de définir les actions à mettre en place auprès des PVVIH et/ou des pharmaciens. [ABSTRACT FROM AUTHOR]

Introduction Les antirétroviraux (ARV), comme la majorité des traitements chroniques, ne peuvent être dispensés en France pour une durée supérieure à un mois sauf dérogation dans le cadre d’un séjour à l’étranger. La marche à suivre côté pharmacien et côté patient n’est pas toujours connue et peut différer d’un département à l’autre. Une cartographie des procédures proposées par chaque Caisse d’Assurance Maladie (CPAM) a été réalisée afin de présenter exhaustivement les règles de dispensation des traitements chroniques en France pour des départs à l’étranger d’une durée supérieure à un mois. Matériels et méthodes Enquête en ligne remplie en janvier 2018 par les membres du groupe MP SFLS (médecins et pharmaciens), sur la base du site internet Ameli.fr (pour chaque département sont présentées les règles de dispensation pour plus d’un mois en cas de départ à l’étranger). Puis cartographie des résultats. Résultats Quatre-vingt-quinze départements français ont été renseignés. Un grand nombre de départements suit les mêmes règles, que ce soit pour 3 ou 6 mois : mention spéciale du médecin sur l’ordonnance (100 %) et demande d’accord à faire en amont par le patient à sa caisse d’assurance maladie (89 %). Mais pour certains départements, notamment en Ile-de-France (10-15 %), les règles diffèrent : pas besoin d’accord de la caisse en amont, mais attestation sur l’honneur à présenter à la pharmacie (séjour > 1 mois à 3 mois) ou à la caisse avec attente d’un accord explicite ou non (séjour 3 à 6 mois). Certains départements ajoutent des conditions supplémentaires (ex : ne pas être sous AME ou accepter le Dossier Pharmaceutique). Deux départements (54 et 74) précisent que les pays de l’UE ne sont pas considérés comme « voyage à l’étranger ». Un seul département (16) explique aux pharmaciens comment faire pour facturer plusieurs mois en une seule fois. Dans tous les départements, la dispensation de plus de 6 mois est interdite et respectée (100 %). Les DOM ne peuvent pas être considérés comme séjour à l’étranger. Conclusion Les règles de dispensation des traitements chroniques, dont les ARV, en cas de voyage à l’étranger sont hétérogènes d’un département à l’autre et ne sont pas toujours connues ni des pharmaciens ni des patients. Certains détails pratiques importants ne sont précisés que par certaines caisses départementales. Certaines situations (voyage de plus de 6 mois) ne sont pas abordées. Le groupe MP SFLS est en relation avec la Caisse Nationale d’Assurance Maladie (CNAM) pour proposer une harmonisation des règles ainsi qu’une clarification des messages passés au pharmacien quel que soit le département. Il en résulterait des explications plus claires au patient et un parcours de soins plus fluide, notamment en cas de changement de département. [ABSTRACT FROM AUTHOR]

This article presents the results of a qualitative research on practices of dispensing antiretroviral medication concerning requests for greater than one month, for departure abroad. In spite of a strict regulation, a cartography shows a heterogeneity of its application leading to a great diversity of dispensing practices. This qualitative research with 22 pharmacies across the territory reveals relational and regulatory logics that contribute to this non-uniformity of practices. The concepts of embarrassment, professional commitment, regulatory concerns and personal relationships with patients largely explain the accommodations and crafts observed in this type of ARV dispensing request.

Initial participation in PRALIMAP-INÉS group activities was high among disadvantaged teenagers with financial difficulties, but it was more difficult to maintain their participation throughout the programme. Identification of factors that can maintain participation is a major challenge for continuity of the programme..

The present and future medical demography is determined by the French government, which decides the number of students in medicine and residents in medical specialties. There are too few students to replace retiring (65-year-old) practitioners. Medical needs may not be met in the coming 20 years. There is an urgent need to increase the number of medical students.

The rigid part of the human body consists essentially of carbonated apatite (calcium phosphate). Biologists don't have any tools to study this "mineral" phase, though its origin is organic. A new approach of some compounds like enamel or bone is obtained with the Raman micro-characterisation by a very fine analysis of chemical bonds in a micrometric scale. This method allows the characterisation, the analysis and the dosage of ions, like carbonate, acid phosphates, proteins and fatty acids. The identification of other organic or mineral compounds (e.g. calcium carbonate, calcium oxide, substitutant ions...) is also possible. The Raman microspectrometry can also be used to study the chemical and physical properties of biomaterials and their evolution after implantation in a dental or bone site. On synthetical calcium phosphate, beta-TCP, brushite and hydroxyapatite can be distinguished and the impurities found in plasma spray deposits can be measured. The detection of alpha-, beta-, or gamma-pyrophosphates could be obtained in some commercial beta-TCP. The Raman microspectrometry is the only non-destructive method which allows the identification of the chemical bonds in a micrometric scale and gives the "fingerprint" of the studied component.

Functional strabism amblyopia is no more a problem: before 2 years old, they are cured in 95%. On the other and, low vision population beyond any medical or surgical treatment is increasing dramatically: over a million persons are concerned. Low vision is usually a consequence of age related macular degeneration related to the increase of life-span. Diabetic retinopathy, severe glaucoma, vitreoretinal disorders and chorioretinal diseases are also important blindness causes. Only a psychosensorial rehabilitation allow persons to see differently by developing functional vision thanks to the development of sensorial neurophysiology and cognitive psychology. This rehabilitation can only take place in well defined institution with a polyvalent team because such institution are so rare in France (4/33 Sweden) the authors ask National Academy of Medicine to beg public authority to create low vision rehabilitation center.

Forty one patients were admitted with a diagnosis of prosthetic valve thrombosis. One patient was thrombolyzed successfully, and 40 underwent surgical procedures. In 13 cases, prosthetic valve thrombosis occurred in the first month after valve replacement. 18 patients were in functional class IV of the NYHA classification. Among the thrombosed prostheses, 91% were mechanical, and 61% in mitral position. Adequacy of anticoagulation was the most important risk factor, as this treatment was inappropriate in 20 patients. In 10 other patients, it had been changed for medical (bleeding events, pregnancy) or surgical (non cardiac surgery) reasons. The perioperative mortality rate was high (32.4%). It was 12% in patients in functional class II and 46% in those in class IV (p < 0.05). This underlines the value of early diagnosis, in which echocardiography, especially with a transesophageal probe, takes a major place, allowing prompt surgical treatment.

The goal of this article is to discuss an overview of literature published from 1968 to 1993 and dealing with links between single-parenting, poverty and mental health. A total of 56 articles were selected based on the most current data banks. Results show that the population of single-parent mothers is growing and that they are becoming increasingly poor. Of the six mental health variables listed by the author, four (psychological distress, self-esteem, perception of one's own skills and psychological isolation) clearly demonstrate that single-parent mothers are in a less healthy mental state than are mothers in two-parent families. Results also indicate that self-esteem, distress and psychological well-being are affected by economic variables. Results therefore vary according to the variable being measured. Although single-parent mothers experience more psychological discomfort than mothers in two-parent families, they do not seem to experience more serious mental health problems. The authors argue that future research on the subject should take into consideration a certain number of aspects, discussed in the conclusion of this article, which account for links between single-parenting, poverty and mental health.

Forty one patients were admitted with a diagnosis of prosthetic valve thrombosis. One patient was thrombolysed successfully, and 40 underwent surgical procedures. In 13 cases, prosthetic valve thrombosis occurred in the first month after valve replacement. 18 patients were in functional class IV of the NYHA classification. Among the thrombosed prostheses, 91% were mechanical, and 61% in mitral position. Adequacy of anti-coagulation was the most important risk factor, as this treatment was inappropriate in 20 patients. In 10 other patients, it had been changed for medical (bleeding events, pregnancy) or surgical (non cardiac surgery) reasons. The perioperative mortality rate was high (32.4%). It was 12% in patients in functional class II and 46% in those in class IV (p < 0.05). This underlines the value of early diagnosis, in which echocardiography, especially with a transesophageal probe, takes a major place, allowing prompt surgical treatment.

Between 1983 and 1989, 15 children underwent surgical repair of interrupted aortic arch at 1 to 20 days of age. The anatomical form was a Celoria and Patton type B in all patients with an associated perimembranous ventricular septal defect in all but one who had multiple ventricular septal defects, and patent ductus arteriosus. Six children had a retro-esophageal right subclavian artery, two had subaortic stenosis and two had a right-sided descending thoracic aorta. In two children with severe hypoplasia of the ascending aorta the repair was performed in one stage with two deaths due to left ventricular failure. In the other B cases, a two-stage repair was carried out. The reconstruction of the aortic arch varied according to the individual case. All children had pulmonary artery banding. Seven children survived longer than 30 days. Six of them later underwent a complete repair. The only survivors were those patients in whom the neo-aortic arch grew harmoniously. The authors conclude that: a two-stage repair gave disappointing results in this series of consecutive patients, mainly because of the poor quality of the reconstruction of the aortic arch by thoracotomy.

The frequency of phrenic nerve palsy varies from 2.5 to 8.3%, according to different authors. Contact of the phrenic nerve with cold (ice or saline) seems to be the most frequent etiology. This study points out that good insulation between phrenic nerve and ice slush, used in the pericardium, results in almost complete disappearance of this complication, which is not a benign one, as emphasized by the two deaths in our series.

One hundred consecutive patients aged 71 to 80 without other cardiac pathology underwent coronary bypass surgery by the same surgical team between January 1986 and May 1989. These patients were recruited from a group of 687 patients undergoing coronary bypass surgery in the same period. The indication was always based on the severity of clinical symptoms resistant to medical therapy. Recent unstable angina despite triple therapy was a particularly common indication in this group of patients (61%). Preoperative coronary angiography showed a high incidence of triple vessel (62 cases) and left main stem disease (23 cases). Double vessel (12 cases) and single vessel disease (3 cases) were less common. Preoperative myocardial infarction was observed in 35% of cases; the site was nearly always on the inferior wall. In all, 230 bypasses were performed including 23 internal mammary artery bypasses (average 2.3 bypasses per patient). Six patients developed perioperative myocardial infarction confirmed by ECG and a rise in cardiac enzymes in 4 cases and by a rise in the cardiac enzymes alone in 2 cases. The mortality was low in this group of patients (3%). This was due to strict selection of patients in this age group and also to the improvement in the techniques of myocardial protection, anaesthesia and intensive care. Our results justify the operative indications in this group of patients in whom medical therapy has failed.

The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve.

The immediate post-operative results of conservative surgery were evaluated objectively in 31 children aged under 13 years referred to us for surgical correction of severe rheumatic mitral valve regurgitation. 16 patients had pure mitral regurgitation. In the others, lesions which required additional surgery were aortic regurgitation in 7 cases, tricuspid of the mitral valve and left ventricle was studied by two-dimensional TM-mode echocardiography. This examination was combined with a pulsed doppler study in search of a possible residual mitral regurgitation signal, with special attention to the depth at which it was recorded in the left atrium -- a semi-quantitative indication of the severity of residual leakage. Two mitral valve replacements were performed, and two early reoperations were needed for residual regurgitation developed between the 5th and 8th post-operative days. Three deaths occurred due to supra-systemic pulmonary arterial hypertension. The post-operative evaluation of mitral valvuloplasty results therefore involved 25 patients. In the absence of significant residual mitral regurgitation, two-dimensional echocardiography was inconclusive since the images obtained varied considerably according to the surgical procedures performed. There was a distinct reduction of end-diastolic diameters (43.5 +/- 5.9 versus 62.1 +/- 8.7 mm pre-operatively), reflecting the disappearance or marked decrease of the pre-operative ventricular volume overload consecutive to mitral regurgitation. The reduction of end-systolic diameters was also significant (31.2 +/- 6.7 mm versus 39.2 +/- 7.1 mm pre-operatively), though less pronounced than that of end-diastolic diameters, which explains the diminution observed in the percentage of fibre shortening, although the figures remained within normal limits (28.7 +/- 9.7 p. 100 versus 37.0 +/- 6.8 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

While the authors recognise the difficulty of obtaining a complete picture of the lesion in certain types of ventricular shunt with pulmonary hypertension, they emphasise the importance of a precise diagnosis, which may modify the medical treatment and the decision to operate. Conditions may nevertheless be found by surprise at operation, and lead to a modification of the planned action.

Two cases of symptomatic aortic arch anomalies in adults are reported: a case of Neuhauser's ligamentum arteriosum with compressive retro-oesophageal diverticulum, and a case of double aortic arch revealed by postoperative tracheal compression. In both cases, surgical correction was made very difficult by the aneurysmal progression of the compressive vascular anomalies and resection of the thoracic aorta under cardiopulmonary by-pass was necessary. These therapeutic difficulties therefore highlight the differences between aortic arch anomalies in adults and those in infants which can be simply and effectively treated with no mortality in our experience. These observations argue in favour of systematic surgical correction of any aortic arch anomalies in infants, even when they are responsible for few symptoms.

The authors describe a new surgical technique used for the repair of coarctations of the aorta with extensive segmental hypoplasia. The technique is divided into four stages: enlargement of part of the hypoplastic segment by arterioplasty, using a flap from the subclavian artery; the extent of possible enlargement is governed by the length of subclavian artery available; resection of the residual hypoplasia and of the coarctation area proper; end-to-end anastomosis of the two aortic segments; revascularization of the arm by direct implantation of the subclavian artery into the left common carotid artery.

Re-establishing continuity between the right ventricle and the division of the pulmonary trunk may prove difficult in surgical correction of transposition of the great vessels. Although prosthetic tubes, which had many drawbacks, have been replaced by direct anastomoses, partial reconstruction of the pulmonary arterial wall is still often necessary. The materials commonly used are segments of gore-tex, stored pericardium and fresh or glutaraldehyde-treated pericardium. However, retractions may develop in these reconstructions resulting in pulmonary stenosis. These complications have revived the debate on the best technique for re-establishing continuity, and it is mandatory to use a growing tissue to keep pace with the child's development. We report here an original technique used in an infant. Previous studies have shown that the autologous pericardial flap, transformed here into a tube, retains its potential for growth.

The authors have studied 25 cases of PPC which were selected according to very strict criteria. These cases represent 1 case of PPC for every 2 687 confinements, and 37.8% of all cardiomyopathies in females of child-bearing age. The females with PPC belonged to the more deprived socio-economic population. Multiparity and twin pregnancies are predisposing factors. The clinical picture is usually one of biventricular of left heart failure. Four cases of embolism are included (16%, which is a high figure for Africa). The special investigations are important. Mechanographic studies show a very significant lengthening of the pre-ejection phase (especially QB1), and a reduced ejection phase; haemodynamic studies show in particular increased pressures on the right side in 4 cases out of 6. (3 of which had an arterio-capillary gradient). Angiocardiography, carried out in 4 cases, showed abnormalities especially of the left ventricle (especially dilation and hypokenesia). The outcome may be favourable, especially after 3 to 6 months have elapsed. However, complications may arise in the long-term (10, 14 and 37 months). There were two deaths (8%). Histologically, the lesions were mainly of a congestive type, with some areas of fibrosis, and rarely areas of inflammation (myocarditis). From the aetiological standpoint, it might be thought that during the posptpartum period, various abnormal conditions prevail or would be discovered (13 in our series); but it is also true that some cases of true PPC, with marked stasis and a tendency to thrombosis, as well as severe involvement of the myocardium (as witnessed especially by the mechanographic findings), to progress after 3 months either to resolution, death, or complications; the histological findings in the two fatal cases were of myocarditis.