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There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique.

Resume Introduction Le nombre de plasties du ligament croise anterieur (LCA) est en constante augmentation en France. Le taux de reruptures peut atteindre 25 %. Le choix du greffon de reprise est toujours difficile. Les allogreffes peuvent etre une solution fiable, encore peu utilisee en France. Hypothese Les allogreffes tendineuses sont des greffons fiables et possibles en France pour des reprises de plasties du LCA. Materiel et methode Il s’agit d’une etude retrospective bicentrique de 39 patients operes entre 2004 et 2016, avec un recul minimum de 1 an. Ont ete inclus, les patients ayant beneficie d’une allogreffe tendineuse lors d’une reprise de plastie du LCA associee ou non a une rupture d’un plan peripherique. Ont ete exclus, les mineurs et les patients aux antecedents ligamentaires controlateraux. L’âge moyen etait de 32 ans. Les allogreffes etaient des appareils extenseurs, des tendons tibiaux anterieurs ou posterieurs, des tendons fascia lata, des tendons d’ischio-jambiers et un court fibulaire. Elles provenaient des Banques de Tissus francaises ou belges. Elles ont ete utilisees pour reconstruire 39 LCA isoles ou associes a 11 ligaments collateraux. Tous les patients ont eu des scores IKDC et KOOS, 31 ont eu une laximetrie realisee par un examinateur independant. Resultats Le recul moyen etait de 3,5 ans. Nous deplorons une arthrolyse, 2 ruptures iteratives mais aucune infection profonde. Les scores IKDC subjectifs et KOOS ont progresse significativement et respectivement de 53,6 et 60,4 a 80,7 et 83,2 points. La laximetrie differentielle postoperatoire moyenne etait de 1,4 mm (KT 1000) et de 1,6 mm (GNRB®). Trois patients etaient sportifs professionnels, deux ont repris au meme niveau a 1 an. 54 % des patients sportifs amateurs ont repris leur sport. Conclusion Dans un contexte de reprise ligamentaire complexe, les allogreffes ligamentaires sont des solutions faibles et possibles en France. Niveau de preuve scientifique IV ; etude de cohorte retrospective.

Online Food packaging films must be reinvented in order to meet the new ecological requirements and challenges. In particular, efforts have been directed to reduce the use of petrochemical polymers and to develop biobased and/or biodegradable polymers. Among those, Poly(ethylene furanoate) (PEF) is a new promising biopolymer with high gas barrier and good mechanical properties, but its high price limits currently its industrial applications. Its combination with another polymer is thus of great interest and film coextrusion could be a relevant processing method for PEF. Nanolayer coextrusion can create hundreds to thousands micro or nanolayers and has been shown to improve the gas barrier properties of some polymers due to various confinement effect [1,2]. In this study, a new grade of PEF, developed by AVA Biochem in the scope of the H2020 Mypack program, has been combined with PET using nanolayer coextrusion. Multilayered films with different PEF layer thicknesses (varying from the micrometer down to the nanometer scale) have been successfully processed. AFM observations have shown the continuity of the PEF layers with individual thicknesses as thin as 40 nm. PEF was amorphous at the end of the coextrusion step and post-thermal annealing was necessary to get a crystallinity degree of 14%. Surprisingly, the gas barrier properties were not improved by the crystallization step. While PEF alone is too brittle to withstand any deformation, it was possible to biaxially stretch amorphous PEF/PET multilayered films with draw ratio as high as 4,5 x 4,5. After a subsequent crystallization, an improvement of a factor 4, compared to the bulk PEF, has been obtained for the gas barrier properties. Projet européen Mypack

online Food packaging films must be reinvented in order to answer the new demanding ecological requirements. Biobased and/or biodegradable polymers appear as an interesting alternative to reduce petroleum dependence and carbon dioxide emissions. Poly(ethylene furanoate) (PEF) appears today as a new promising biopolymer thanks to its good gas barrier and mechanical properties, despite its high price that could limit its industrial applications. Its combination with other polymers is thus of great interest and for the first time, film coextrusion process is used to create PLA-PEF and PET-PEF multi-micro/nano layered films. A new PEF grade developed by AVA Biochem in the H2020 Mypack program, has been used and firstly analysed in terms of melt processability, mechanical, thermal and gas barrier properties. Our major results confirmed the good gas barrier as well as mechanical properties of amorphous PEF. Post-extrusion PEF bulk thermal crystallization led to very brittle material making gas barrier measurements impossible. Micro/nanolayered PLA-PEF and PET-PEF films with different PEF layer thicknesses have been processed and post-extrusion annealing treatment was carried out. The relationship between crystallinity, mechanical and gas barrier properties will be investigated. Projet européen Mypack

Objectives: Loss of osteochondral substances resulting from osteochondritis dissecans (OCD) of the knee are arthrogenic in the long term. When they exceed 2 cm2, the Autologous Matrix Induced Chondrogenesis (AMIC®) technique is one of the methods used in France. The objective of this study was to evaluate the medium-term results of the AMIC® technique. Methods: This was a consecutive, prospective, single-center, single-operator series of 22 patients (13 men, 9 women, mean age 28 years (15-51)) treated by AMIC® (spongy bone graft + sutured collagen membrane) between September 2011 and November 2016. Previous surgery had been performed on 17 patients. According to the ICRS classification, the lesion was stage IV in 21 cases and stage III in 1 case. The sites were: condylar: 19 cases, patellar: 2 cases and trochlear: 1 case. The mean surface area was 3.6 cm2 (2-8) and the depth was 0.5 mm (0.4-0.8). All the patients were functionally assessed by an independent examiner using validated functional scores for these indications (KOOS, subjective IKDC). Student’s T tests were used. Results: At a mean follow-up of 4 years (minimum 2 years) all but 2 patients had significantly improved (In preop. IKDC: 44±14 and KOOS: 56±17). In these 2 cases, the postoperative scores remained unchanged over the years: one patient had had several surgeries before the graft and a 51-year-old female patient had an extensive lesion of 6.9 cm2. The mean IKDC and KOOS scores were 73±18 and 78±15 and then 77±16 and 81±14 respectively, at 1 and 4 years (p> 0.05 for IKDC and KOOS). Regrettably there were 2 complications: 1 arthrolysis 1 year after surgery and 1 algodystrophy. Conclusion: Few techniques are available in France for extensive symptomatic osteochondral lesions. AMIC® is a reliable, one-step, reproducible, inexpensive technique for loss of substance due to OCD with stable results as of 1 year after surgery.

Background The number of anterior cruciate ligament (ACL) reconstructions is steadily rising in France. Re-tear rates of up to 25% have been reported and graft selection remains a notable challenge. Allografts, although rarely used in France, can be a viable option. The primary objective of this study was to demonstrate the benefits of ACL revision with allografts, by determining subjective scores (IKDC score and KOOS), measuring laxity, and evaluating the rate of return to sports. Hypothesis Tendon allografts are reliable and can be used in France for ACL reconstruction revision. Material and methods We conducted a retrospective study including 39 patients managed in two centres between 2004 and 2016 and followed up for at least a year. Patients were eligible if they had undergone tendon allograft reconstruction for ACL revision with or without rupture of a peripheral plane. We excluded underage patients and patients with a history of ligament injury in the contralateral knee. Mean age was 32 years. The allografts were extensor mechanisms, anterior or posterior tibial tendons, fascia lata tendons, hamstring tendons, and a short fibular tendon. They were obtained from French and Belgian tissue banks. They were used for the reconstruction of 39 ACLs and 11 collateral ligaments. The IKDC score and KOOS were determined in all patients. Laximetry was performed in 31 patients by an independent examiner. Results Mean follow-up was 3.5 years. Arthroscopic release was required in one patient, and 2 patients experienced re-tears. No deep surgical site infections were recorded. The subjective IKDC score and the KOOS improved significantly, from 53.6 to 80.7 and from 60.4 to 83.2, respectively. Mean postoperative differential laxity was 1.4 mm (KT 1000) and 1.6 mm (GNRB®). Of the 3 patients who were professional athletes, 2 had returned to sports at the same level one year later, and among the recreational athletes, 54% had resumed their previous sporting activities. Conclusion In the setting of complex ligament reconstruction revision, tendon allografts are reliable and can be used in France. Level of evidence IV; retrospective cohort study.

Decades of research make clear: children’s early experiences in life have lasting effects on their odds of good health and success in school, work and life. It is during early childhood that the fo...

A million new neural connections are formed every second in a baby's brain These connections lay the foundations of their lifelong development, and are shaped by the amount and quality of care they receive from their primary caregivers, and by their immediate environment To protect their health and limit negative consequences from COVID-19 on their long-term development, cities need to tailor their COVID-19 response to the needs of babies, toddlers, and their caregivers The COVID-19 pandemic affects babies and toddlers in cities by making it harder for their caregivers - most often their parents - to access their regular support systems, due to closures of services and key infrastructure such as parks, mobility restrictions, or isolation from the community Cities can actively support caregivers through a range of solutions allowing remote access, or adapting infrastructure, services, and facilities to ensure safe in-person access to key services and urban spaces This does not always require new solutions, but rather a systematic consideration of their needs into existing interventions To do so, cities can combine empathy methods with data about families, and use those when assessing the situation, and then locating and designing their urban response to COVID-19

Introduction Les ruptures de plasties du LCA conduisent le plus souvent a une reprise par une autogreffe car les allogreffes semblent impossibles, inaccessibles voir risquees, pour beaucoup de chirurgiens. Materiel et methodes Il s’agissait d’une etude prospective de 37 patients operes entre 2004 et 2017 et ayant un suivi superieur a 12 mois. Ont ete inclus des sportifs de loisir, genes par leur instabilite. Ont ete exclus, les sportifs de haut niveau ou professionnels. L’âge moyen etait de 38 ans (21–68). Les allogreffes se decomposaient en greffe du tendon tibialis anterieur ou posterieur (16 cas), greffe de tendon patellaire (14 cas), greffe de semi tendineux (2 cas), greffe de facia lata (4 cas) et greffe de court peronier lateral (1 cas). Trent cinq patients ont eu une tenodese extra articulaire en association a la plastie intra articulaire, 13 une plastie postero-laterale ou mediale et pour 2 une osteotomie tibiale de valgisation. Tous ont ete evalues par un examinateur independant. Les tests de Student ont ete pratiques. Resultats Tous les patients ont ete interroges ou revus au recul moyen de 49 mois (12–140). Il n’y a eu aucune infection profonde. Un patient a ete repris par PTG, 2 patients ont eu une rerupture (2 et 4 ans post greffe). Les scores IKDC et KOOS moyens sont passes respectivement de 55 ± 13 a 80 ± 16 points (p > 0,05) et de 58 ± 11 a 85 ± 17 points (p > 0,05). La laximetrie differentielle au KT-1000 s’est reduite de 4,7 ± 2,3 mm en pre-operatoire a 1,4 ± 1,7 mm en post-op. Avec le GNRB®, la laximetrie differentielle s’est reduite de 4,8 ± 2,4 mm en pre-op a 1,5 ± 1,7 mm en post-op. (p > 0,05). Discussion Les resultats subjectifs et objectifs des allogreffes sont comparables a ceux des reprises par autogreffe (K-J ou DI-DT) dans la litterature (Trojani C, 2012, Shelbourne D, 2014, Grassi A, 2017). Les avantages de l’utilisation d’une allogreffe sont nombreux : absence de morbidite du prelevement, gain de temps operatoire, possibilite d’adapter la greffe aux pertes de substances osseuses et recuperation plus rapide. Les inconvenients sont : risques theoriques de contamination bacterienne, virale ou fungique et ligamentisation plus longue. Conclusion Les allogreffes sont legales et possibles en France et leurs resultats dans une population de sportifs de loisir sont encourageants. Les facteurs limitants en France sont la faible disponibilite et le cout des allogreffes.

In this paper,we present the implementation of a dedicated software, MAP-OPT, for optimising the design of ModifiedAtmosphere Packaging of refrigerated fresh, nonrespiring food products. The core principle of this software is to simulate the impact of gas (O2/CO2) exchanges on the growth of gas-sensitive microorganisms in the packed food system. In its simplest way, this tool, associated with a data warehouse storing food, bacteria and packaging properties, allows the user to explore his/her system in a user-friendly manner by adjusting/changing the pack geometry, packaging material and gas composition (mixture of O2/CO2/N2). Via the @Web application, the data warehouse associated with MAP-OPT is structured by an ontology, which allows data to be collected and stored in a standardized format and vocabulary in order to be easily retrieved using a standard querying methodology. In an optimisation approach, the MAP-OPT software enables to determine the packaging characteristics (e.g. gas permeability) suitable for a target application (e.g. maximal bacterial population at the best-before-date). These targeted permeabilities are then used to query the packaging data warehouse using the@Web applicationwhich proposes a ranking of the most satisfying materials for the target application (i.e. packaging materialswhose characteristics are the closest to the target ones identified by the MAP-OPT software). This approach allows a more rational dimensioning of MAP of non-respiring food products by selecting the packaging material fitted to “just necessary” (and not by default, that with the greatest barrier properties). A working example of MAP dimensioning for a strictly anaerobic, CO2-sensitive microorganism, Pseudomonas fluorescens, is given to highlight the usefulness of the software.

Predicting microbial safety of fresh products in modified atmosphere packaging implies to take into account the dynamic of O2, CO2 and N2 exchanges in the system and its effect on microbial growth. In this paper a mechanistic model coupling gas transfer and predictive microbiology was validated using dedicated challenge-tests performed on poultry meat, fresh salmon and processed cheese, inoculated with either Listeria monocytogenes or Pseudomonas fluorescens and packed in commercially used packaging materials (tray + lid films). The model succeeded in predicting the relative variation of O2, CO2 and N2 partial pressure in headspace and the growth of the studied microorganisms without any parameter identification. This work highlighted that the respiration of the targeted microorganism itself and/or that of the naturally present microflora could not be neglected in most of the cases, and could, in the particular case of aerobic microbes contribute to limit the growth by removing all residual O2 in the package. This work also confirmed the low sensitivity of L. monocytogenes toward CO2 while that of P. fluorescens permitted to efficiently prevent its growth by choosing the right combination of packaging gas permeability value and initial % of CO2 initially flushed in the pack.

We describe a case of late post-partum haemorrhage from uterine artery pseudo-aneurysm secondary to the vascular trauma induced by a previous caesarean section. This rare aetiology should be known by anaesthesiologists since treatment by arterial embolization is safe and effective whereas curettage usually recommended for primary post-partum haemorrhage can aggravate the bleeding. This diagnosis should be considered in front of late genital bleeding without obvious cause and lead to perform a sonographic examination with Doppler-scan before diagnostic and therapeutic arteriography, eventually preceded by diagnostic MRI.

Objective To study subsequent fertility of patients who underwent embolization of the uterine arteries to treat postpartum hemorrhage. Design Retrospective cohort study between January 2000 and June 2006 with two patient groups: exposed and nonexposed to embolization for postpartum hemorrhage. Setting Level 3 maternity unit. Patient(s) Fifty-three patients exposed to embolization and 106 nonexposed patients were included and paired according to several criteria: date of delivery, age, parity, whether the pregnancy was spontaneous or with fertility assistance, and mode of delivery. Intervention(s) None. Main Outcomes Measure(s) Occurence of pregnancy. Result(s) Among patients exposed to embolization, 14 had been exposed to pregnancy and 12 had been pregnant. There was no statistically significant difference of occurrence of pregnancy between the nonembolized and embolized groups ( P =.30). Conclusion(s) According to the results, it seems that embolization does not alter subsequent fertility. This study nevertheless suggests a trend toward fewer pregnancies in the embolization group and reports three severe complications in that group. This trend deserves to be explored by further studies with higher statistical power. However, even if it would be difficult to provide complete reassurance to patients who have undergone embolization, better information regarding their subsequent fertility and potential risks could relieve them of their worries regarding a new pregnancy.

In France, coagulation blood tests are usually ordered before performing an epidural anaesthesia. This French habit obeys to the fear of triggering an epidural haematoma induced by neuraxial anaesthesia. This analysis of literature shows that these practices do not protect anaesthesiologists against this clinical risk or its medico-legal consequences. As shown by epidemiological studies, epidural haematoma in pregnancy is associated to the occurrence of HELLP syndrome. On the opposite, gestational thrombocytopenia is not associated to any bleeding risk. According to the recommendations of the French Society of Anaesthesia (Sfar), only a clinical examination and an interrogatory must be done to diagnose coagulation defects before general or loco regional anaesthesia. Normal pregnancy is not an exception to this rule except for the platelet number which must be evaluated during the 3rd trimester of pregnancy. This platelet numeration might detect a rare idiopathic thrombopenic purpura. This recommendation is valid only for normal pregnancy. The clinician must ensure that pregnancy is still normal by seeking for symptoms of pregnancy-induced pathology such as preeclampsia or HELLP syndrome before setting an epidural anaesthesia. The possibly late occurrence of these complications during the per- or post-partum explain why a coagulation test performed even a few days before anaesthesia may not allow to detect any coagulation defect favouring the risk of epidural haematoma.

Predicting microbial safety of fresh products in Modified Atmosphere Packaging (MAP) systems implies to take into account the dynamic of O2 and CO2 exchanges in the system and its effect on microbial growth. In this purpose we coupled mathematical models of gas transfer (permeation through packaging and solubilisation / diffusion within food) with predictive microbiology models that take into account the effect of CO2 and O2 partial pressure in headspace and corresponding dissolved concentrations in the food. This mechanistic model was validated in simplified and in real conditions using dedicated challenge-tests performed on poultry meat, fresh salmon and processed cheese, inoculated with either Listeria monocytogenes or Pseudomonas fluorescens. Once validated, this model could be used as a Decision Support Tool in order to optimize the initial packaging atmosphere (level of O2 and CO2) and / or the geometry (ratio headspace volume to food mass). This tool could also be used to identify the packaging gas permeability the most suitable for maintaining the targeted % of gas initially flushed in the pack within a given tolerance. This approach permits a better dimensioning of MAP of fresh produce by selecting the packaging material fitted to “just necessary” (and not by default the most barrier one). The connexion of this model with dedicated databases gathering gas permeabilities of commonly used packaging materials allows us to obtain as output a ranking of the most suitable materials. This tool would be very useful for all stakeholders of the fresh produce chain. A demonstration of this Decision Support Tool is here proposed with the pipeline between mathematical models and related databases.

The performances of Modified Atmosphere Packaging (MAP) for perishable foodstuffs depend mainly on food composition, on the initial microbiological qualities, on the nature of the packaging and on gaz contents. The expected shelf life will be limited by the bacterial development and the evolution of organoleptic properties. The solubility of the gas and diffusion according to the food are going to determine its efficiency. The permeability of the packaging will act on the partial pressures in gas. Methods were developed, data and models were acquired allowing the determination and the optimization of the efficiency of modified atmospheres packaging. Computing and analytical methods were used for the collection of data required for the establishment of mathematical models. Data on permeability’s properties of packaging were acquired from published data by methods used in engineering of the knowledge in order to integrate in a semi automatic way data from heterogeneous and multiple sources. A database on the packaging permeability data and on gaz solubility and of diffusivity data was then established. A synthesis of the available methods for the measures of the solubility and the diffusivity of O2 and CO2 was realized. The solubility in the CO2 was acquired by chemical titration and reaction with a scavenger based on barium, and that of O2 by luminescence. The diffusivity of gases is acquired by local quantification, determination of the gradients of gas and modelling. Methods of quantification of the effect of the CO2 on bacteria independently of the acidification were developed and thus the active agent was identified as the ion H2CO3. The largest concentration of CO2 that prevent the growth (CMI) were determined. The bacterial effect of CO2 was quantified by determining the minimal inhibitory concentration. For the aerobic germs, the kinetic of growth according to the content in O2 was modelled and for the anaerobic the maximal quantities allowing the growth were acquired. The laws of gases transfers were combined with bacterial growth models. The models for gases transfers were validated in the food. The effects of gases on the bacterial development on food were combined with already existing models on the effects of temperature and pH. A modelling tool was developed. The results of the project will allow the companies to optimize packaging size and composition, to reduce their volume, to guarantee shelf life without preservative and also to avoid the wasting.; Les performances des conditionnements sous gaz de denrées alimentaires périssables dépendent principalement de la composition en gaz, de la qualité microbiologique initiale de l’aliment et de la nature de l’emballage. Les durées de vie des produits alimentaires sont limitées par le développement bactérien et son impact sur la sécurité sanitaire et les propriétés organoleptiques. La solubilité du gaz, sa diffusivité dans l'aliment détermineront également son efficacité. La perméabilité de l'emballage agira également sur la pression partielle en gaz. Des développements informatiques et des méthodes analytiques ont été utilisées pour collecter les données nécessaires à l'établissement de modèle mathématiques.....

Resume Objectif. – Evaluer la cure de prolapsus par voie basse chez la femme tres âgee. Patientes et methodes. – Etude retrospective sur 38 patientes âgees de plus de 80 ans, operees d'une cure de prolapsus genital par voie basse entre novembre 1997 et octobre 2004. Ont ete evalues l'etat general des patientes, le type d'analgesie, le geste et le temps operatoire, les complications per- et postoperatoires et le devenir des patientes a un mois de l'intervention. Resultats. – L'âge moyen des patientes etait de 84,2 ans (80–95). L'etat general des patientes, selon la classification ASA, se repartissait en 55,3 % ASA II et en 44,7 % ASA III. L'anesthesie realisee etait dans 92,1 % une anesthesie generale et dans 7,9 % une anesthesie locoregionale. Le type d'intervention pratiquee etait dans 68,4 % une hysterectomie voie basse associee a un Marion-Kelly et une perineorraphie posterieure, dans 13,1 % une hysterectomie voie basse simple associee plus ou moins a la pose d'un TVT, dans 10,5 % une intervention de Lefort, un cas de sacrospinofixation de Richter et un cas de colpectomie simple. Le temps operatoire moyen etait de 43 minutes (10–130). Les complications peroperatoires se resumaient en une conversion en voie haute pour hemorragie, et un cas de ligature de l'uretere droit. Le passage en unite de soins intensifs durant 24 heures n'etait necessaire que dans un cas sur 38. Les complications postoperatoires etaient dans un cas un deces a j11 des suites d'une embolie pulmonaire, un cas de desorientation temporospatiale grave et une recidive de prolapsus a six mois. La duree moyenne de sejour hospitalier etait de sept jours (2–18). La chirurgie n'avait dans aucun cas altere l'autonomie des patientes a un mois. Discussion et conclusion. – La chirurgie du prolapsus par voie basse chez la femme tres âgee est realisable en pratique courante. Elle necessite une bonne cooperation anesthesiochirurgicale. Le risque vital est bien present mais relatif. Cette chirurgie fonctionnelle ne doit pas etre retardee par la pose d'un pessaire, ce dernier ne devant etre reserve qu'aux patientes inoperables.

In clinical practice, the only tests of platelet function are bleeding time and platelet number. Bleeding time lacks sensitivity and specificity but the PFA-100, an in vitro analyser of platelet function may be of value. This study aimed to evaluate any correlation between platelet number and function using the PFA-100 in pregnant women. During a 21-month period, platelet function was evaluated in whole blood as part of the pre-anaesthetic coagulation testing screen with the PFA-100 using collagen and epinephrine (PFA-EPI) or ADP (PFA-ADP) as platelet agonists. Thrombocytopenia was defined as a platelet number less than 150 G litre(-1). The patients were divided into four groups: Group I (n=110) normal pregnancy; Group II (n=38) thrombocytopenia of pregnancy; Group III (n=13) women with pre-eclampsia without thrombocytopenia; Group IV (n=19) women with pre-eclampsia and thrombocytopenia. Results are expressed as mean (SD). Platelet count was not statistically different between Groups II and IV (111.1 (23.1) vs 99.5 (28.0) G litre(-1)). PFA-EPI was statistically increased in Group II (124.0 (26.3) s), Group III (128.3 (17.9) s), and Group IV (143.6 (47.7) s) compared with normal pregnant patients (114.6 (27.3) s, P0.05, Mann-Whitney U-test). PFA-ADP was statistically increased only in Group II compared with normal pregnant patients (90.5 (18.9) vs 80.2 (11.2) s, P0.05). PFA values were increased above normal laboratory values in (four of 38) Group II patients and (six of 19) Group IV patients but in no patients in Group III. PFA-ADP results were correlated with platelet count only in Group IV (r=-0.74, P=0.0003). The increased PFA values and the correlation between PFA-ADP and platelet number in hypertensive thrombocytopenic women confirms that platelet function may be decreased in such patients. In patients with pregnancy-induced thrombocytopenia, platelet function may be preserved when the platelet count is as low as 60 G litre(-1).

International audience

Introduction Recemment, le role pivot du fibrinogene et de la fibrinolyse a ete mis en evidence dans la severite de l’hemorragie (1). Notre protocole de prise en charge des hemorragies du post-partum (HPP) comprend l’administration precoce de fibrinogene et d’acide tranexamique (AT) apres la sulprostone. Cette etude retrospective comparant la periode 1 : 2000–2004 et la periode 2 : 2009–2011 avait pour but la mise en evidence d’une epargne transfusionnelle. Methodes Les patientes ont ete selectionnees a partir du dossier obstetrical informatise, des donnees SIME et de l’hemovigilance. L’HPP etait definie par une perte sanguine > 500vmL en cas d’accouchement par voie basse, et 1000 mL en cas de cesarienne, dans les 24 h suivant l’accouchement. L’HPP grave etait definie par le recours a une transfusion > 4 culots globulaires (CG) ou a une technique d’hemostase chirurgicale ou radiologique. Les donnees entre les 2 periodes ont ete comparees par test de Fischer ou par ANOVA (moyenne ± ET) avec p Resultats Nous avons observe une epargne transfusionnelle dans le groupe de parturientes necessitant une transfusion (p Discussion Une epargne transfusionnelle et une reduction des pertes sanguines calculees sont observees chez les transfusees. L’incidence des coagulopathies et de la transfusion massive diminue egalement. L’utilisation plus large d’AT et/ou de fibrinogene associee au respect des recommandations (2) pourrait expliquer ces resultats.

Twenty ASA 1 pregnant women at term, undergoing elective Caesarean section were included in this study. They were randomly assigned to one of two groups, receiving either a spinal or an epidural anaesthesia. Before induction, in order to prevent hypotension, all patients were given an i.v. infusion of 1000 ml of Ringer-lactate and a subcutaneous injection of ephedrine 30 mg. They were positioned on the operating table with a 15 degrees left lateral tilt. Spinal anaesthesia was performed with hyperbaric bupivacaine 0.5 p. cent (0.08 mg.cm-1 of height). Epidural anaesthesia was obtained with a bolus dose of 0.5 p. cent plain bupivacaine, followed by a continuous infusion through the epidural catheter until the level of surgical block reached T6 bilaterally. Bupivacaine was assayed in plasma by high performance liquid chromatography (HPLC). Following pharmacokinetic parameters of bupivacaine were determined: Cmax (maximal concentration), Tmax (time to reach maximum), AUC (area under curve), Cl (total plasma clearance), Vz (volume of distribution during the elimination phase), T1/2 (elimination half-life). Bupivacaine concentration was also measured in samples obtained at birth from umbilical vein and umbilical artery. The mean dose of bupivacaine used was 12.8 +/- 0.6 mg in the spinal group and 118.6 +/- 17.8 mg in the epidural group. The time of onset of surgical anaesthesia was significantly shorter with spinal anaesthesia (7.6 +/- 4.4 vs 31 +/- 11.1 min; p < 0.01). The sensory block had a longer duration in epidural group (223.2 +/- 15 vs 291 +/- 13.8; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)