Blessé médullaire: prise en charge en andrologie

Sexual reactions are under neurological control. Spinal cord trauma alters neurological structure and induces sexual dysfunction. Pharmacological drugs used currently allow erectile function to be recovered in spinal cord-injured men, an essential step towards the resumption of a sex life. Triggering of ejaculation is often difficult. Perineal stimulation techniques, used either in isolation or in association with pharmacological treatment, promote ejaculation and allow sperm collection and freezing. The possibility of achieving ejaculation during sexual intercourse in spinal cord-injured men remains rare and there is as yet no real therapy available. Despite poor semen quality, spinal cord-injured men maintain reproductive possibilities in 40 to 60% of couples. The use of assisted reproductive technologies is often required. Management of sexual dysfunction in spinal cord-injured men must be integrated into a rehabilitation and re-insertion programme.     

Microsporum canis en gatos dermatológicamente sanos en Temuco,Chile

BackgroundMicrosporum canis is the most common cause of feline dermatophytosis and the most pathogenic fungus isolated from the skin and hair of healthy cats. Cats are considered to be the natural reservoir and infection sourse of this disease in human and domestic animals.AimsKnowing the M. canis frequency in the dermatological healthy cat population of Temuco city, Chile.MethodsFifty cat samples were collected irrespective sex or race. Cats' ages were between 2 months and 12 years old, and the animals were treated at the Veterinary Clinical Hospital of the Universidad Católica de Temuco, or in three private clinics from this city. Tissue and hair samples were collected using two sampling techniques: hair extracting tweezers and the Mariat & Tapia method. For the clinical diagnosis, the Wood's lamp was used. Hairs were microscopically observed followed by a culture using Sabouraud agar and Lactrimel agar. M.canis was isolated in 30 cats (60%).ResultsThere were no statistically significative differences when parameters such as age, sex and race were taking into account. Differences between the use of Sabouraud agar and Lactrimel agar were not registered. It was determined that the Mariat & Tapia method was able to detect more dermatophytes than the collecting tweezers method. These differences were statistically significative.ConclusionsThe percentage of M. canis isolation obtained in this work remarks the role of healthy cats in the transmission of these dermatophytes to humans and other animals.     

Réévaluation des dosages de PSA disponibles en France en 2012

The evaluation kits PSA conducted in 2004 by AFSSAPS resumed in 2012 using the same methodology to update the performance of assays available on the French market. Preference should be given to equimolar and accurate assays of PSA for uniform clinical use and correct kinetic monitoring.     

Prevención de las caídas basada en la evidencia en Europa

ProFaNE (Prevention of Falls Network Europe) is a thematic network funded by the European Commission. This network brings together scientists, clinicians and other health professionals from across Europe to focus on four main topics (taxonomy and co-ordination of trials, clinical assessment and management of falls, assessment of balance function, and psychological aspects of falls). There are 24 members across Europe as well as Network Associates who contribute expertise at workshops and meetings. ProFa- NE, a 4-year project which started in January 2003, aims to improve and standardise healthcare processes by introducing and promoting good practice throughout Europe. ProFaNE has its own website (http://www.profane.eu.org) and undertakes workshops to bring together experts and observers involved in specific topics to exchange knowledge, expertise and resources on interventions to reduce falls. The present article discusses ProFaNE's achievements to date and the work in progress to achieve good clinical practice and research into the prevention of falls across Europe.     

Vitamina B12 en pacientes diabéticos tipo 2 en tratamiento con metformina

ObjectiveTo test vitamin B12 plasma levels in type 2 diabetic patients treated with metformin in our area.MethodsA cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic.ResultsOne hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1,779 mg/day. Patients treated with metformin had significantly lower vitamin B₁₂ plasma levels (393.5 vs. 509 pg/mL, P = .0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B₁₂ plasma levels lower than 197 pg/mL. No correlation was found between vitamin B12 plasma levles and metformin treatment time or dosage.ConclusionsIn type 2 diabetic patients, treatment with metformin is associated to lower vitamin B12 plasma levels. Vitamin B12 deficiency associated with metformin is relatively common in our area.     

Cyclische episoden van verwardheid en bewegingsstoornissen: denk aan hypoglykemieën en insulinoom

Insulinomas are rare neuroendocrine tumours of the pancreas which present with neuroglycopenic and autonomic symptoms induced by hypoglycemic periods. The onset is insidious. Because of atypical symptoms like temporary movement disorders and behavioural disturbances the diagnosis is often made at a late stage. We describe two patients with cyclic behavioural and movement disorders caused by already present but not recognised insulinomas. The treatment options are discussed, in which the most common surgical therapy is not always a first choice in elderly patients with comorbidity. With drug therapy patients can be free of symptoms for a longer period without any significant complications.     

Anomalies surrénaliennes en pratique quotidienne en TEP/TDM au 18F-FDG

Adrenal masses are common in adult population and are a daily challenge for nuclear physicians. The aim for physicians is to differentiate benign from malignant lesions when therapeutic management is impacted. 18F-FDG PET/CT combines complementary modalities, providing structural and functional information, superior to that provided by CT or PET alone. The purpose of this review is to provide some keys that will help to be familiar with the common as well as the atypical manifestations of adrenal disease.     

Alta prevalencia de obesidad en una población laboral en España

Background and objectivesTo report the prevalence of obesity in a Spanish working population and its changes in recent years.Material and methodsData were collected from routine medical examinations performed on workers by a national mutual insurance society for occupational accidents and diseases (Ibermutuamur). A structured questionnaire was completed and physical examinations were performed. Overweight was defined as BMI ranging from 25 and 29.9, obesity as BMI of 30-39.9, and morbid obesity as BMI ≥ 40 kg/m².ResultsData from 1,336,055 medical examinations performed from May 2004 to November 2007 were collected. Prevalence rates in the population examined in 2004 (n = 230,684; 73% males; average age, 36.4 years) were: morbid obesity, 0.5% (0.6% males, 0.5% females); obesity, 14.5% (17.0% males, 7.7% females); overweight, 38.4% (44.8% males, 21.3% females). Prevalence rates of obesity and overweight were higher in blue-collar workers (16.4% and 40.5% respectively) as compared to white-collar workers (10.9% and 34.4% respectively). There was a progressive increase in prevalence of obesity during the 4-year study (2004-2007) in both males (17.0%, 17.6%, 17.9%, 18.2%) and females (7.6%, 8.0%, 8.4%, 8.7%).ConclusionsPrevalence of obesity and overweight in the Spanish working population is high, especially in male blue-collar workers, and is increasing. There is a need to promote early prevention programs and specific treatments for obesity.     

Micafungina en el tratamiento de la infección fúngica en modelos animales

BackgroundMicafungin is an echinocandin antifungal drug recently approved for the treatment of candidiasis. The possibility of its clinical use against other invasive mycoses, has aroused the interest of numerous investigators in evaluating its efficacy in different animal models.ObjectivesTo critically review the current data on the use of micafungin in the treatment of invasive mycoses in animal models.MethodsWe searched the PubMed/Medline data base (National Library of Medicine) from 2005 to 2008, both inclusive, on the use of micafungin in the experimental treatment of the fungal infection.Results and conclusionsSeven, of a total of 18 articles reviewed, were done in animal models of candidiasis and six in animal models of pulmonary or SNC aspergillosis. Similarly to the other echinocandins, caspofungin and anidulafungin, micafungin seems to exert a fungicidal activity against Candida albicans and Candida glabrata and a fungistatic activity against Aspergillus fumigatus. The paradoxical effect observed in lung tissue the experimental caspofungin treatment of aspergillosis has not been seen in the case of micafungin. The available data demonstrate a higher efficacy of micafungin versus fluconazole in the experimental treatment of C. albicans infections caused by strains susceptible in vitro to both drugs. To improve the efficacy of micafungin in the treatment of C. glabrata and A. fumigatus infections, several authors have tested different combined therapies, the combination of micafungin with amphotericin B being that showed the best results.     

Illustrations cliniques en pédiatrie

The examples and clinical cases presented in this section are not intended to be considered as absolute models in terms of image quality or device parameter settings. They must initiate an individual analysis according to CT parameters and image quality. Nevertheless, they present practically different CT levels which can be used according to the clinical context and the type of device.     

Proactieve en gestructureerde zorg voor kwetsbare oudere patiënten in de eerstelijn: Achtergrond, opzet en uitvoering van een screenings- en zorgprogramma

Background

Currently, primary care for the older, vulnerable patient is reactive, fragmented and does not meet patients needs. Given the expected increase of home-dwelling frail elderly people a transition is needed to proactive and integrated care.

Methods

In the described study, we explore two innovative interventions in primary care. First we describe a newly developed screening and monitoring program for frail elderly patients based on routine care information in general practice. Second, we describe a multidisciplinary intervention program by trained nurses for frail elderly patients in general practice. The effectiveness of the interventions is examined in a three-armed, cluster randomized trial, taking place in 58 primary care practices in Utrecht, the Bilt and Maarsenbroek.

Results

Three thousand eight patients are included. Primary outcome measure is the impact of the interventions on the daily activities, measured with the Katz questionnaire. Secondary outcomes measures are the quality of life, mortality, recording in a care or nursing home, visit to an emergency room or outpatient unit, recording in the hospital and volunteer caregivers tax.     

Illustrations cliniques en ostéo-articulaire

The examples and clinical cases presented in this section are not intended to be considered as absolute models in terms of image quality or device parameter settings. They must initiate an individual analysis according to CT parameters and image quality. Nevertheless, they present practically different CT levels, which can be used according to the clinical context and the type of device.     

Incidencia y factores explicativos de las caídas en ancianos que viven en la comunidad

Introductionfalls in the elderly are a significant health problem that can be prevented once risk factors have been identified. The objective of this study was to determine the rate of falls among elderly persons living in the community and their risk factors.Patients and methodstwo hundred ambulatory individuals aged 75 years or older attending an outpatient clinic were evaluated by personal interview. Demographic and social variables, health characteristics, use of healthcare resources and falls were studied. Bivariate analysis was performed and significant variables were entered into a conditional logistic regression analysis.Resultsthe rate of falls per year was 56.5% and rate of recurrent falls was 10.5%. The factors associated with falls in the logistic regression model were living with a spouse (OR = 0.37), taking three or more drugs (OR = 5.30), cardiovascular diseases (OR = 0.29), and taking nitrates (OR = 0.21). The factors associated with recurrent falls were change of home (OR = 11.10), living with a spouse (OR = 0.20), respiratory (OR = 6.44) and cardiovascular diseases (OR = 0.27), and taking laxatives (OR = 9.55).Conclusionsin our study the rate of falls and recurrent falls was similar to that described in other studies in western countries. Our results suggest that taking at least three medications and the use of laxatives were potentially preventable risk factors. Living with a spouse seemed to protect from both falls and recurrent falls in elderly people living in the community.     

Especies de Aspergillus en ambientes hospitalarios con pacientes pediátricos en estado crítico

BackgroundAspergillus is a group of opportunistic fungi that cause infections, with high morbimortality in immunosuppressed patients. Aspergillus fumigatus is the most frequent species in these infections, although the incidence of other species has increased in the last few years.AimsTo evaluate the air fungal load and the diversity of Aspergillus species in hospitals with pediatric patients in critical condition.MethodsThe Intensive Care Unit and Burns Unit of a pediatric hospital were sampled every 15 days during the autumn and spring seasons. The air samples were collected with SAS Super 100^® and the surface samples were collected by swab method.ResultsThe UFC/m³ counts found exceeded the acceptable levels. The UFC/m³ and the diversity of Aspergillus species found in the Intensive Care Unit were higher than those found in the Burns Unit. The fungal load and the diversity of species within the units were higher than those in control environments. The use of both methods –SAS and swab– allowed the detection of a higher diversity of species, with 96 strains of Aspergillus being isolated and 12 species identified. The outstanding findings were Aspergillus sydowii, Aspergillus niger, Aspergillus flavus, Aspergillus terreus and Aspergillus parasiticus, due to their high frequency. Aspergillus fumigatus, considered unacceptable in indoor environments, was isolated in both units.ConclusionsAspergillus was present with high frequency in these units. Several species are of interest in public health for being potential pathogenic agents. Air control and monitoring are essential in the prevention of these infections.