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The optimal management of pain is crucial to facilitate perioperative rehabilitation. These well-known principles apply to patients after a cesarean section or a vaginal delivery. Indeed, if the cesarean has been considered as a reproducible model of acute pain, acute pain have been largely underestimated or ignored after vaginal delivery, andhas been taken into account only recently. Perineal pain is indeed very common: duration and intensity are correlated with the severity of tissue damage. They may be an obstacle to postpartum rehabilitation. For the physician, post-partum rehabilitation focused on appropriate analgesic strategies should also take into account the specificities of the post-partum period which are motherchild relationship, breastfeeding facilitation and newborn care. Beyond the immediate postpartum rehabilitation, consideration and treatment of acute pain also prevent the emergence of persistent pain and post-partum depressions. Indeed, severity of acute post-partum pain but not mode of delivery is related to the risk of persistent pain and postpartum depressions.

Over the period 2010-2012, maternal mortality from infectious causes accounted for 5% of maternal deaths by direct causes and 16% of maternal deaths by indirect causes. Among the 22 deaths caused by infection occurred during this period, 6 deaths were attributed to direct causes from genital tract origin, confirming thus the decrease in direct maternal deaths by infection during the last ten years. On the contrary, indirect maternal deaths by infection, from extragenital origin, doubled during the same period, with 16 deaths in the last triennium, dominated by winter respiratory infections, particularly influenza: the 2009-2010 influenza A (H1N1) virus pandemic was the leading cause of indirect maternal mortality by infection during the studied period. The main infectious agents involved in maternal deaths from direct causes were Streptococcus A, Escherichia Coli and Clostridium perfringens: these bacterias were responsible for toxic shock syndrome, severe sepsis, secondary in some cases to cellulitis or necrotizing fasciitis. Of the 6 deaths due to direct infection, 4 were considered avoidable because of inadequate management: delayed or missed diagnosis, delayed or inadequate initiation of a specific medical and/or surgical treatment. Of the 16 indirect maternal deaths due to infection causes, the most often involved infectious agents were influenza A (H1N1) virus and Streptococcus pneumonia with induced purpura fulminans: the absence of influenza vaccination during pregnancy, delayed diagnosis and emergency initiation of a specific treatment, were the main contributory factors to these deaths and their avoidability in 70% of the cases analyzed.

© 2017 Royal College of Obstetricians and Gynaecologists Objective: Develop a core outcome set of international consensus definitions for severe maternal morbidities. Design: Electronic Delphi study. Setting: International. Population: Eight expert panels. Methods: All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. Main outcome measures: Definitions with a rate of agreement of more than 70%. Results: The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. Conclusion: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. Tweetable abstract: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.

The risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy.We conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery.Fifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P0.001).Using measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.

Face aux considerables opportunites d’investissement offertes par ses mutations demographiques, urbaines et economiques, l’AfSS est devenu un veritable terrain d’action pour les acteurs du capital-investissement. Les grands bailleurs de fonds sont en train d'etre remplaces par des investisseurs de plus en plus diversifies. Cet interet grandissant des investisseurs montre que l’image de la region s’ameliore. Il existe toutefois aujourd’hui un risque de « surchauffe ». Les acteurs doivent s’adapter aux specificites de l’AfSS, caracterisee par des operations de petite taille dans des contextes d’entrepreneurs familiaux qui ne souhaitent pas ceder la majorite. Ainsi, les fonds de private equity investissant en Afrique ont une triple utilite : mobiliser l’epargne longue disponible et l’investir dans des projets de qualite, fournir les fonds propres necessaires aux entreprises en forte croissance, et reduire l’ecart entre les industriels des pays developpes et des pays emergents.Classification JEL : F21, G11, G24, O16, O55.

Dans la periode perinatale, patients et soignants sont confrontes a des peurs de types differents. La crainte de survenue d’evenements indesirables graves (EIG) pour les patientes et leurs enfants domine les peurs des soignants. Differentes strategies d’anticipation et de prevention des EIG ont ete developpees : elles passent par leur reconnaissance, leur analyse et en particulier la recherche de leur evitabilite en se placant dans une demarche continue d’amelioration des pratiques professionnelles. Les patientes peuvent etre, quant a elles, confrontees a des peurs « a priori », liees aux nombreuses incertitudes et inconnues de la periode perinatale pour elle et leur enfant, mais aussi a des peurs « a posteriori », pouvant aller jusqu’a un etat de stress post-traumatique (ESPT), qui peut perturber l’etablissement du lien mere-enfant, et conditionner le vecu des grossesses ulterieures. Permettre aux patientes d’acceder pendant toute la periode perinatale, a des informations claires et detaillees, de beneficier d’une communication et d’une attention humaine adaptee, ainsi que depister precocement des symptomes d’ESPT en post-natal, constituent les principaux moyens a mettre en oeuvre pour minimiser l’anxiete, prevenir la survenue d’un ESPT et favoriser la relation mere-enfant.

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.

For several years, total intravenous anaesthesia (TIVA) has demonstrated many advantages that allow considering propofol anaesthesia as an interesting alternative in pediatric anaesthesia. TCI in children requires calculation and validation of pharmacokinetic (PK) models specifically adapted to the paediatric population. Several PK models based on a 3-compartement approach have been proposed in children: all these models, which integrate only weight as covariable, show increased distribution volumes with a wide interindividual variability. The particular importance to include physiological covariables, as age and lean body mass, to describe metabolic processes during growth and maturation in pediatric PKPD models is in agreement with recent allometric scaling works in children. However, as pharmacodynamic (PD) parameters are still debated in children, there is up to now, no PKPD model currently available for paediatric anaesthesia. Schnider et al.'s model, a model described in adults that includes numerous covariables, may be adapted and more efficient than the classical paediatric models to describe propofol-PKPD relationship in children over 5years. Whatever the model, a pharmacodynamic feedback such as the bispectral index may be useful to counteract interindividual variability in the paediatric population.

Background Sevoflurane has become the gold standard for inhalation induction in children. However in children as in adults, epileptiform electroencephalographic signs have been described under high concentrations of sevoflurane. The aim of this study was to determine the minimal alveolar concentration (MAC) of sevoflurane associated with the occurrence of major epileptiform signs (MES) in 50% children under steady-state conditions. The MAC of MES (MAC MES) was determined in 100% oxygen and with the addition of 50% nitrous oxide or after the injection of alfentanil (ALFENTA). Methods Seventy-nine children (3-11 yr), undergoing elective surgery and premedicated with hydroxyzine were included. After induction by inhalation and tracheal intubation, a 10-min period with a stable expired fraction of sevoflurane was obtained. The MES were defined as rhythmic polyspikes or epileptiform discharges. Electroencephalographic recordings were blindly analyzed by two independent experts. The MAC MES were determined by the Dixon method: the concentration of sevoflurane was determined by the result from the previous patient: increase of 0.2% if MES were absent or decrease of 0.2% if MES were present. Three consecutive series were performed: (1) in 100% oxygen (MAC MESO2); (2) in 50% oxygen and 50% nitrous oxide (MAC MESN2O); and (3) in 100% oxygen with a bolus of alfentanil (MAC MESALFENTA). Results The MAC MESO2 was 4.3±0.1% (mean±SD), the MAC MESN2O and the MAC MESALFENTA were higher, respectively: 4.6±0.2% (P=0.01) and 4.6±0.2% (P=0.02). Conclusions In children premedicated with hydroxyzine, the MAC MES of sevoflurane calculated in 100% O2 corresponded to 1.75 surgical MAC. In addition, our results have demonstrated a moderate effect of nitrous oxide and alfentanil in raising the threshold of MES.

To evaluate feasibility of performing benign gynecologic pathology low pressure (7mmHg) laparoscopy (LPL) with AirSealIn this prospective randomized pilot study, 60 patients had laparoscopy for gynecologic benign pathology: 30 with 7mmHg and AirSeal system, and 30 with 15mmHg standard insufflator. The primary endpoint was incidence of shoulder pain. A postoperative questionnaire was completed by each patient to assess shoulder pain (Numeric Rating Scale [NRS], from 0 to 10) at H4, H8, H24, and consumption of morphinics was notified. During each procedure, anesthesia parameters were collected (peak airway pressure, systolic blood pressure, end tidal COLaparoscopy was performed on 30 patients in AirSealLP (7mmHg) laparoscopy with AirSeal

SummaryBackground In children, only a few studies have compared different modes of propofol infusion during a total intravenous anesthesia (TIVA) with propofol and remifentanil. The aim of this study was to compare Bispectral Index (BIS) profiles (percentage of time spent at adequate BIS values) between four modes of propofol infusion: titration of the infusion rate on clinical signs (TIVA0), titration of the infusion rate on the BIS (TIVABIS), target controlled infusion (TCI) guided by the BIS either with the Kataria model (TCI KBIS) or the Schnider model (TCI SBIS). Methods Sixty-six children (aged from 4 to 14 years) were prospectively randomized into one of the four groups. In the TIVA0 group, the anesthesiologist was blinded to the BIS. In each group, the percentage of time with adequate BIS values (45–55), the bias, and imprecision were calculated. Results The propofol consumption was similar in the four groups. During the maintenance phase, the percentage of time spent in the targeted BIS range was significantly lower in the TIVA0 group compared to the three other groups (TIVA0: 31% ± 22, TIVABIS: 59% ± 17, TCI KBIS: 53% ± 12, TCI SBIS: 56% ± 17). The bias was not statistically different between the four groups, but the imprecision was larger for the TIVA0 group. Compared to the Kataria model, the Schnider model was associated with shorter time delay to reach the desired BIS, to eyes opening, and to tracheal extubation. Conclusions Propofol administration using manual infusion guided by clinical signs was associated with higher risks of over- or underdosage when compared to BIS-guided administrations. When propofol infusion was guided by the BIS, no major difference was found between TIVA and TCI (either with the Kataria or the Schnider model). This study highlights the need of a pharmacodynamic feedback during propofol anesthesia in children.

Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy and the course of pregnancy did not differ from that of healthy subjects in terms of miscarriages, fetal bleeding and pre-term births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but 2 of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8% to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of abnormal blood loss was increased with respect to the general population. However, no mother died or had to undergo hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery below 50 × 10(9)/L. Fil: Noris, Patrizia. Istituti di Ricovero e Cura a Carattere Scientifico. Policlinico San Matteo di Pavia; Italia. Università degli Studi di Pavia; Italia Fil: Schlegel, Nicole. Université Paris Diderot - Paris 7; Francia Fil: Klersy, Catherine. Istituti di Ricovero e Cura a Carattere Scientifico. Policlinico San Matteo di Pavia; Italia Fil: Heller, Paula Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Civaschi, Elisa. Università degli Studi di Pavia; Italia Fil: Pujol Moix, Nuria. Universitat Autònoma de Barcelona; España Fil: Fabris, Fabrizio. Università di Padova; Italia Fil: Favier, Remi. Inserm; Francia. Armand Trousseau Children’s Hospital; Francia. French Reference Center for Inherited Platelet disorders; Francia Fil: Gresele, Paolo. Università di Perugia; Italia Fil: Latger Cannard, Véronique. Centre Hospitalo-Universitaire. Service d’Hématologie Biologique; Francia. Reference French Centre. Centre de Compétence Nord-Est des Pathologies Plaquettaires; Francia Fil: Cuker, Adam. University of Pennsylvania; Estados Unidos Fil: Nurden, Paquita. Hôpital Xavier Arnozan; Francia Fil: Greinacher, Andreas. Institut für Immunologie und Transfusionsmedizin; Alemania Fil: Cattaneo, Marco. Università degli Studi di Milano; Italia Fil: De Candia, Erica. Università Cattolica del Sacro Cuore; Italia Fil: Pecci, Alessandro. Università degli Studi di Pavia; Italia Fil: Hurtaud Roux, Marie Françoise. Université Paris Diderot - Paris 7; Francia Fil: Glembotsky, Ana Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Muñiz Diaz, Eduardo. Banc de Sang i Teixits de Catalunya. Immunohematology Department; España Fil: Randi, Maria Luigia. Università di Padova; Italia Fil: Trillot, Nathalie. Centre Hospitalier Régional Universitaire de Lille. Pôle Biologie Pathologie Génétique. Institut d’Hématologie-Transfusion; Francia Fil: Bury, Loredana. Università di Perugia; Italia Fil: Lecompte, Thomas. Hôpitaux Universitaires de Genève; Suiza. Université de Genève. Faculté de Médecine; Suiza Fil: Marconi, Caterina. Università di Bologna; Italia Fil: Savoia, Anna. Università degli Studi di Trieste; Italia Fil: Balduini, Carlo L.. Istituti di Ricovero e Cura a Carattere Scientifico Burlo Garofolo. Institute for Maternal and Child Health; Italia. Università degli Studi di Pavia; Italia Fil: European Hematology Association Scientific Working Group on Thrombocytopenias and Platelet Function Disorders. No especifica

For several years, total intravenous anesthesia (TIVA) has demonstrated many advantages that allow consideration of propofol anesthesia as an interesting alternative in pediatric anesthesia. TIVA in children requires calculation and validation of pharmacokinetic (PK) models specifically adapted to the pediatric population. Several PK models based on a 3-compartment approach have been proposed in children: all these models, which integrate only weight as covariable, show increased distribution volumes with a wide interindividual variability. However, as pharmacodynamic (PD) parameters are still debated in children, there is up to now, no PKPD model currently available for pediatric anesthesia. The particular importance to include physiological covariables, as size and age, to describe metabolic processes during growth and maturation in pediatric PKPD models is in agreement with recent allometric scaling works in children. The Schnider's model, a model described in adults that includes numerous covariables, may be adapted and more efficient than the classical pediatric model to describe propofol-PKPD relationship in children over 5 years. Whatever is the model, a pharmacodynamic feed back such as the bispectral index may be useful to counteract the interindividual variability in the pediatric population.

In this prospective study, we compared the relationship between propofol concentrations and bispectral index (BIS) in children versus young adults anesthetized with target-controlled infusion (TCI) of propofol.Forty-five prepubertal subjects (children) and 45 postpubertal subjects (adults) were studied. All patients were anesthetized with TCI of propofol, based on the Kataria et al.'s model for children and on the Schnider et al.'s model for adults. All data from the BIS and the TCI system were continuously recorded using Rugloop software. Remifentanil was continuously administered throughout the study (0.25 microg x kg(-1) x min(-1)). In all patients, after the end of surgery, a 12-min period with a stable target plasma concentration (Ct) of propofol, randomly assigned at 2, 3, 4, 5, and 6 microg/mL, was performed. In addition, in most of the patients, another 12-min period was performed during which the BIS was targeted at 50 +/- 5. After each 12-min steady-state period, the Ct and BIS were noted and the plasma concentration of propofol was measured (Cm). The Ct and Cm corresponding to half maximal effect (BIS(50)) was determined by the Hill equation, and by targeting BIS at 50.In children, as in adults, BIS values were highly correlated with the corresponding Ct or Cm of propofol following classical E(max) dose-response curves. The ECt(50) and the ECm(50), derived from the dose-response curves, were higher in children than in adults: ECm(50): 4.0 (3.6-4.5) microg/mL vs 3.3 (3.0-3.7) microg/mL [mean (95% CI)], P0.001; as well were the Ct and Cm clinically obtained when BIS was targeted at 50 (Cm(50): 4.3 +/- 1.1 microg/mL vs 3.4 +/- 1.2 microg/mL, (mean +/- SD) P0.05, children versus adults). Cm was generally under-estimated by the Ct, and the bias was higher in children than in adults: 2.6 +/- 2.6 microg/mL vs 1.7 +/- 1.6 microg/mL (P = 0.05).The good relationship between propofol and BIS demonstrated in children as in adults suggested a slightly lower sensitivity to propofol in children. As the predictability of plasma propofol concentrations with the classical pharmacokinetic/pharmacodynamic models is limited in children, a cerebral pharmacodynamic feedback, such as BIS, may be useful in this population.

To present the preliminary results of the PRIUM study, a French pilot study of prenatal repair for myelomeningoceles (MMC).The fetal surgery for MMC is offered in cases of patients that did not opt for termination of pregnancy.Thirty-six patients were referred in an 18-month period. Eight patients were not eligible for prenatal repair. Another type of dysraphism was made in 6 cases (one spina-lipoma, 5 cases of limited dorsal myeloschisis). Twenty-two patients were eligible to fetal surgery. A prenatal repair was performed in three cases (14%). Four patients opted for a conventional postnatal treatment. Fifteen patients opted for termination of the pregnancy.The establishment of a prenatal repair of MMC protocol in France was justified. The experience of the first 18months of this study however suggests that only a limited number of couples will choose this procedure after specialized counseling in a reference center.

Venous thromboembolism is a leading cause of maternal mortality in many countries, including France. Most enquiries have repeatedly demonstrated that many deaths could be avoided, suggesting the need to update and ensure a wider diffusion of recommendations. Although thromboembolism-induced maternal death plays a major role, the absolute incidence of events remains low, reducing the ability to perform well-designed research and the level of recommendations presented. Many personal or pregnancy-related factors have been identified as increasing the risk of thromboembolism in pregnant patients but few of them have been associated with a significantly increased risk. A history of thromboembolic event and some thrombophilic factors (including antithrombin deficiency and antiphospholipid syndrome) carry the greatest risk. Pregnancy itself, caesarean delivery and the postpartum period, although associated with an increased risk play a minor role when not combined with other risk factors. Prophylactic treatment relies mainly on low molecular weight heparins which safety is now well established in pregnant patients. Dose and duration of treatment should be adapted to the perceived level of risk. The occurrence of a thromboembolic event is also increased after gynaecological surgery but major and cancer surgery carry the greatest risk. Here also, low molecular weight heparins play a leading role, although non pharmacologic means are useful. Dose and duration should be dependent on the level of risk.

"Les herbes parlent au curieux (attentif) médecin par leur signature, lui descouvrant par quelque ressemblance leurs vertus intérieures, cachées sous le voile du silence de la Nature", Oswald Crollius, La Royale Chimie, 1624. A l’origine des savoirs traditionnels sur les plantes médicinales, nous retrouvons d’une part l’observation fine, attentive et globale des plantes dans leur milieu naturel, d’autre part l’expérimentation empirique de remèdes populaires réalisés par la pratique des lois d...

For several years, total intravenous anaesthesia (TIVA) has demonstrated many advantages that allow considering propofol anaesthesia as an interesting alternative in pediatric anaesthesia. TCI in children requires calculation and validation of pharmacokinetic (PK) models specifically adapted to the paediatric population. Several PK models based on a 3-compartement approach have been proposed in children: all these models, which integrate only weight as covariable, show increased distribution volumes with a wide interindividual variability. The particular importance to include physiological covariables, as age and lean body mass, to describe metabolic processes during growth and maturation in pediatric PKPD models is in agreement with recent allometric scaling works in children. However, as pharmacodynamic (PD) parameters are still debated in children, there is up to now, no PKPD model currently available for paediatric anaesthesia. Schnider et al.'s model, a model described in adults that includes numerous covariables, may be adapted and more efficient than the classical paediatric models to describe propofol-PKPD relationship in children over 5years. Whatever the model, a pharmacodynamic feedback such as the bispectral index may be useful to counteract interindividual variability in the paediatric population.

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.

Background The aim of this study was to identify the best model to describe pharmacokinetics and pharmacodynamics in prepubertal children and therefore to calculate the corresponding pharmacodynamic parameters. In addition, and to confirm our method, a group of postpubertal subjects was also studied. Methods Sixteen children (9.5 yr, range 6-12) and 13 adults (22 yr, range 13-35) were included. Induction was performed by plasma target-controlled infusion of propofol (6 microg/ml) based on the Kataria model in children and on the Schnider model in adults. The relationship of bispectral index to predicted concentrations was studied during induction using the Kataria, pediatric Marsh, Schüttler, and Schnider models in children. Because the best performance was obtained, strangely enough, with the Schnider model, the two groups were pooled to investigate influence of puberty on pharmacodynamic parameters (kE0 [plasma effect-site equilibration rate constant] and Ce50 [effect-site concentration corresponding with 50% of the maximal effect]). The time-to-peak effect was calculated, and the kE0 was determined for the Kataria model (nonlinear mixed-effects modeling; pkpdtools). Results In children, the predicted concentration/effect relationship was best described using the Schnider model. When the whole population was considered, a significant improvement in this model was obtained using puberty as a covariate for kE0 and Ce50. The time to peak effect, Tpeak (median, 0.71 [range, 0.37-1.64] and 1.73 [1.4-2.68] min), and the Ce50 (3.71 [1.88-4.4] and 3.07 [2.95-5.21] microg/ml) were shorter and higher, respectively, in children than in adults. The kE0 linked to the Kataria model was 4.6 [1.4-11] min. Conclusions In children, the predicted concentration/effect relationships were best described using the Schnider model described for adults compared with classic pediatric models. The study suggests that the Schnider model might be useful for propofol target-control infusion in children.

Inter and intraspecific variation was analyzed in two Catharanthus species with regard to isozyme polymorphism and indole alkaloid content in roots and leaves. No significant differences in alkaloid production were observed in three groups of C. roseus plants individualized for their flower color. Conversely, comparisons between C. trichophyllus and C. roseus, showed large differences of alkaloid profiles in both roots and leaves. Specific isozyme markers on four presumed loci were found allowing us to establish that natural hybridizations could occur between the two species when grown together. Experimental hybridizations confirmed that introgressions were feasiblebut suggested that a reproductive barrier was acting and involved interspecific incompatibility. The identification and assay of the main alkaloid compounds in natural interspecific hybrids displayed such a high hybrid vigor that interspecific hybridization may present a new and successful way of improving alkaloid production in Catharanthus species.

International audience; Venous thromboembolism is a leading cause of maternal mortality in many countries, including France. Most enquiries have repeatedly demonstrated that many deaths could be avoided, suggesting the need to update and ensure a wider diffusion of recommendations. Although thromboembolism-induced maternal death plays a major role, the absolute incidence of events remains low, reducing the ability to perform well-designed research and the level of recommendations presented. Many personal or pregnancy-related factors have been identified as increasing the risk of thromboembolism in pregnant patients but few of them have been associated with a significantly increased risk. A history of thromboembolic event and some thrombophilic factors (including antithrombin deficiency and antiphospholipid syndrome) carry the greatest risk. Pregnancy itself, caesarean delivery and the postpartum period, although associated with an increased risk play a minor role when not combined with other risk factors. Prophylactic treatment relies mainly on low molecular weight heparins which safety is now well established in pregnant patients. Dose and duration of treatment should be adapted to the perceived level of risk. The occurrence of a thromboembolic event is also increased after gynaecological surgery but major and cancer surgery carry the greatest risk. Here also, low molecular weight heparins play a leading role, although non pharmacologic means are useful. Dose and duration should be dependent on the level of risk.

"Les herbes parlent au curieux (attentif) medecin par leur signature, lui descouvrant par quelque ressemblance leurs vertus interieures, cachees sous le voile du silence de la Nature", Oswald Crollius, La Royale Chimie, 1624. A l’origine des savoirs traditionnels sur les plantes medicinales, nous retrouvons d’une part l’observation fine, attentive et globale des plantes dans leur milieu naturel, d’autre part l’experimentation empirique de remedes populaires realises par la pratique des lois d...

L'origine des pharmacopées traditionnelles L'élaboration des pharmacopées Les médicaments du XXIe siècle Comment les connaissances des savoirs thérapeutiques se sont-elles transmises au travers des différentes cultures ? Cet ouvrage innovant, qui réunit les travaux présentés au 4e Congrès européen d'ethnopharmacologie, fait remonter à la préhistoire les sources des connaissances thérapeutiques. Si les pharmacopées écrites jalonnent l'histoire des grandes médecines savantes, d'autres modes d'accès à la connaissance semblent exister dans l'univers chamanique des sociétés de tradition orale ainsi que dans la façon dont les animaux malades se soignent par les plantes. L'évaluation des propriétés pharmaco-toxicologiques et chimiques des plantes d'usage traditionnel devrait par ailleurs favoriser le développement futur des médicaments à base de plantes, l'un des thèmes porteurs abordés dans cet ouvrage. Mais l'objectif de ce livre est aussi de susciter, partout dans le monde, de nouvelles thématiques de recherche dans le domaine de la préhistoire du médicament et de la compréhension de l'acquisition et de la transmission du savoir. Le développement du phytomédicament non toxique destiné à l'homme et à l'animal figure également parmi les enjeux majeurs de demain. The origin of traditional pharmacopoeias The development of pharmacopoeias The medicines of the XXIth century How have the traditional Therapeutical knowledges been transmited to the différent cultures? This innovating book containing the proceedings of the 4th European Congress of Ethnopharmacology return to prehistory the sources of fherapeutical knowledge and asks how the animals cure themselves with plants. If the printing pharmacopoeias ponctuate the history of learning medicines other way of accessibility to the knowledge seems exist in the world of shaman in society with oral tradition. Ethnopharmacological evaluation of traditional médicinal plant should favour the development of phytomedicine. The purpose of this publication is also to provide dues to scientists in the whole world and help them identify new avenues for research in the field of the prehistory of drugs, for a better understanding of the way knowledge is acquired and then transmitted, and for the development of non-toxic herbal medicines for administration to human and animal beings.

Introduction Dans une maternite de type 3 de plus de 3000 naissances, la presence d’un IADE poste en salle de naissance (SDN) joue un role important dans la surveillance et l’optimisation de l’analgesie peridurale (APD) obstetricale. Les reinjections peridurales par l’IADE, apres evaluation clinique, doivent etre faites sous couvert de prescription medicale [1] . Le but de cette etude est l’evaluation d’un protocole de prise en charge par les IADE d’une APD obstetricale non optimale, sous forme d’un arbre decisionnel ( Fig. 1 ). Materiel et methodes Enquete prospective observationnelle menee d’avril 2013 a mars 2014 sous forme d’EPP. Apres chaque intervention par l’IADE en SDN pour APD non optimale, sur la base du protocole, une fiche descriptive sous forme de questionnaire a ete remplie par l’IADE. L’objectif principal du questionnaire etait d’evaluer le pourcentage d’analgesie optimisee apres intervention de l’IADE. Les objectifs secondaires etaient l’analyse des echecs d’analgesie (niveau symetrique insuffisant (NSI), defaut de puissance (DP), niveau asymetrique (NA)), l’evaluation du suivi conforme au protocole, les situations eventuelles non prevues par ce dernier et le taux d’interventions secondaires sous anesthesie generale (AG). Resultats Sur une periode de 11 mois, 85 questionnaires ont ete remplis a la suite d’appels pour APD non satisfaisante. Dans 84 % des cas la premiere intervention par l’IADE sur la base du protocole a ete efficace et suffisante, tandis que dans 16 % des cas une seconde intervention a ete necessaire apres appel du MAR. Les causes retrouvees d’APD inefficace etaient par ordre de frequence decroissante un DP (76 %), un NSI (13 %), un NA (11 %). L’intervention etait en adequation avec le protocole dans 81 % des cas et l’administration inadaptee de clonidine etait l’erreur de suivi du protocole la plus frequente dans les autres cas. Le protocole etait applicable a toutes les situations rencontrees. Une seconde pose d’APD a ete realisee avec succes chez trois patientes. Une cesarienne a ete necessaire en cours de travail pour 13 patientes (15 %) dont 12 sous APD et 1 sous AG. Discussion La surveillance reguliere et l’optimisation de l’APD obstetricale permet de limiter les echecs et d’eviter le recours a l’AG dans certains cas [2] . La mise a disposition d’un protocole d’evaluation et de reinjection en cas d’APD inefficace permet a l’IADE de jouer un role important dans le depistage et la prise en charge de la plupart des APD inefficaces permettant une meilleure optimisation de l’APD et limitant ainsi le recours a l’AG en cas d’echec.

Au Cameroun, la culture de l'arabica est confrontée actuellement à de graves problèmes: l'âge des caféiers et leur sensibilité à l'anthracnose des baies (CBD); - la diminution régulière du prix d'achat au planteur; - la transformation des systèmes de culture vers une diversification (vivriers, etc..) s'effectuant au détriment de la caféïculture. La relance de la production ne peut s'envisager qu'avec la diffusion de plants sélectionnés, notamment pour la résistance à l'anthracnose des baies, la lutte chimique contre cette maladie étant toujours contraignante et coûteuse. A partir de l'évaluation du comportement au champ de différents génotypes, des graines récoltées sur des caféiers présentent divers niveaux de résistance ont été semées pour effectuer des inoculations artificielles sur les hypocotyles. L'obtention de bonnes corrélations entre les niveaux de sensibilité observés au champ et les réactions obtenues en laboratoire, devrait nous permettre l'élaboration de tests précoces fiables. Ce travail d'évaluation se heurte à des difficultés d'utilisation et de conservation du matériel végétai en collection. La biotechnologie propose une solution à ce problème en assurant la multiplication des génotypes intéressants, grâce à des techniques déjà mises au point. Au Centre de Biotechnologie de Nkolbisson, une collection de microboutures et d'embryons zygotiques, ainsi que des expériences d'embryogénèse somatique sont développées depuis un an. Ce matériel in vitro est actuellement utilisé pour la réalisation de tests en laboratoire; des essais de toxicité de filtrats, issus de cultures en milieu liquide de C. coffeanum, sont effectués sur ces plantules, en parallèle avec des inoculations artificielles sur plantules in vivo. (Texte intégral)