[Late paternity: spermatogenetic aspects].

The effect of maternal age on the risk of meiotic abnormality is well documented. In contrast little is known about the effect of the paternal age. The question of the risk related to paternal age is raised because of the increased demand of Assisted Reproduction Techniques for older men.

[Arousal disorders].

Altered states of consciousness are a common reason for visits to the emergency room and admission to intensive care unit. Management of unconscious patient can be difficult because the potential causes of an altered mental status are considerable and the time for diagnosis and effective intervention is short. First, the patient must airway, breathing, and circulation protected.

Foetal kidney maldevelopment in maternal use of angiotensin II type I receptor antagonists.

We report renal lesions observed in a foetus exposed throughout pregnancy to angiotensin II type I (AT 1) receptor antagonists. The mother suffered from essential hypertension and was treated with Cozaar (losartan 50 mg). Autopsy examination of the foetus revealed severe renal lesions, including tubular dysgenesis, hypertrophy of the endothelial and medial cells lining the arterial and arteriolar walls, hyperplasia of the juxtaglomerular apparatus and poorly developed vasa recta.

[The counselling of patient with prior C-section].

A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. Information and counselling aim to estimate specific risks and to balance these risks according to individual factors. Therefore, the physician has to answer two questions: (i) which would be the probability of successful vaginal delivery? (ii) which would be the risk of uterine rupture with a trial of labor? The risk factors for failure of trial of labor are: increased maternal age, obesity, and fetal macrosomia.

Should electronic faucets be used in intensive care and hematology units?

Objective: To compare bacterial contamination associated with electronic faucets and manual faucets in wards admitting patients highly susceptible to infection.

Design: Water samples from electronic faucets and manual faucets were taken according to the French recommendations on water surveillance in healthcare settings.

Setting: Hematology and intensive care units (ICUs) of a 900-bed university hospital and a 500-bed general hospital.

[Epidemiology of catheter-related infections in intensive care unit].

Catheter-related infections remain an important cause of nosocomial infection in the ICU. They include colonization of the device, exit-site infection and catheter-related bloodstream infection with or without bacteraemia. Data from clinical studies and surveillance networks should be compared cautiously due to important methodological differences and wide variations of device-utilization ratio between units or countries.

[First trimester Down syndrome screening program using nuchal translucency and maternal serum markers: the Echo PAPP-A.78 study].

Successive development of different methods to screen down syndrome (DS) have had unexpected effects, leading to an inflation in the number of karyotypes ordered and the number of induced abortions. In our district (Yvelines, France), DS screening leads to perform 16% karyotypes rate. Rapid progress in biology and ultrasonography has enabled us to correct this overprescription by conducting an early screening program using a combination of ultrasound graphic and new biochemical markers (Pregnancy-associated plasma protein A and the free fraction of ss-hCG) which allow an overall evaluation of risk.

Does ICU-acquired paresis lengthen weaning from mechanical ventilation?

Objective: To determine whether ICU-acquired paresis (ICUAP) is an independent risk factor of prolonged weaning.

Design: Second study of a prospective cohort of 95 patients who were enrolled in an incidence and risk factor study of ICUAP.

Setting: Three medical and two surgical ICUs in four hospitals.

Prevention of venous thromboembolism in critically ill medical patients: a Franco-Canadian cross-sectional study.

Background: Medical intensive care unit (ICU) patients are at moderate risk of venous thromboembolism (VTE) and prophylaxis against VTE is recommended.

Objectives: To observe the range and frequency of VTE prophylaxis administered to medical ICU patients and to determine factors associated with different strategies in French and Canadian ICUs.

Design: Prospective cross-sectional observational study.

Adaptation to the Intensive Care Environment (ATICE): development and validation of a new sedation assessment instrument.

Objective: To develop a valid, reliable, and responsive bedside instrument assessing Adaptation to the Intensive Care Environment (ATICE) in mechanically ventilated adult intensive care unit (ICU) patients.

Design: Instrument development and prospective clinimetric evaluation.

Setting: University-affiliated medical ICU.

[Discovery of caput succedaneum after premature rupture of the membranes at 28 weeks gestation].

Caput succedaneum often occurs at birth, especially in vaginal delivery. It is a cranial subcutaneous serohematic extravasation, with a good prognosis, and spontaneous regression is the rule within a few days. In the literature, it has been mainly described in the neonatal period.

Paresis acquired in the intensive care unit: a prospective multicenter study.

Context: Although electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown.

Objectives: To assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP.

Design: Prospective cohort study conducted from March 1999 to June 2000.

[Grmek, the "thunderbolt", "thunder-clapp" (as testimony)].

The paper details how the author (who was a young physician) met, ...

Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year.

Objective: To assess the prognosis of patients with acute ischemic stroke who require mechanical ventilation and to determine early factors influencing mortality.

Design: Prospective observational study.

Setting: Medical intensive care unit with a cerebrovascular emergency unit in a university-affiliated hospital.

Using and understanding sedation scoring systems: a systematic review.

Objective: To systematically review instruments for measuring the level and effectiveness of sedation in adult and pediatric ICU patients.

Study Identification: We searched MEDLINE, EMBASE, the Cochrane Library and reference lists of the relevant articles. We selected studies if the sedation instrument reported items related to consciousness and one or more additional items related to the effectiveness or side effects of sedation.

[An unknown cause of prolonged fever: apropos of 6 cases of chronic aortic dissection].

Purpose: Aortic arch dissection may be sometimes misdiagnosed due to the lack of mild to moderate chest pain. Definite diagnosis is often made while dissection has already occurred more than 15 days ago, being thereafter considered as chronic. Aortic dissection may then present as a prolonged febrile illness with fever and/or inflammation as main symptoms, with little or no pain.