Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg最新文献

Since more than 3 decades now, music with seniors (or younger persons), either as an educational or recreational activity, but also as a therapeutically approach has progressed. Even nowadays, in the medical field, more and more studies prove its efficiency as complementary therapy with no known side-effects. The areas where music therapy has a positive outcome, reach from pulmonary disorders to a lot of neurological chronic diseases, including aphasia, dementia or Parkinson. And at the end of life, music therapy has found a remarkable place for expressing or supporting strong emotional feelings. Evidence-based results on physiological and hormonal changes will also be reviewed.

We present a case of giant melanoma of the scalp observed in our department. It is a rare but very aggressive pathology which is generally treated by radical surgery. We emphasize early diagnosis because a large extension of the tumor can lead to the need of a very extensive surgical resection. Prognosis is very severe despite adjuvant medical treatments.

Diffusion tensor imaging (DTI) can be used to localise the visual pathway (VP). In the service of the neurosurgery we have been working since the beginning of this year to develop a protocol which is suitable for the every day clinical routine to show the tracts of the white matter. Many lesions of the brain concern the white matter. Up to date it is still difficult to portray the visual pathway. Many centers all around the world are actually trying to localize the visual pathway, yet it is still used for the research. The application of the DTI-data for surgical interventions remains still a rarity. We believe that using this technique it would reduce the intraoperative risk and improve the postoperative outcome. From the beginning of this year we have been able to localize the visual pathway in 14 patients with different illnesses and we performed also postoperative controls. Using this new technique we were able to minimize the intraoperative risk in our patients.

Background: Prognosis after cardiac arrest is variable and difficult to predict. Early prognostic markers would facilitate the care of these patients.

Aims: Therefore, we evaluated the impact of initial interventions after resuscitation on neurological outcome at 6 months.

Material and methods: We conducted a retrospective analysis of the patient charts from consecutive cardiac arrest patients admitted to our intensive care unit and treated with induced hypothermia.

Results: Over a 3-year period, 90 patients were included in our study. Sixty-four percent of the patients had bystander cardio-pulmonary resuscitation. An automated external defibrillator (AED) was used in 19% of the patients and the mean time to first defibrillation was 11 +/- 8.9 minutes. Patients being resuscitated and defibrillated by bystanders did better than those who had CPR only and far better than those patients in whom no rescue measures where attempted at all (73% vs. 56% vs. 32% for good neurological outcome, respectively, p= 0.03). Witnessed cardiac arrest was more frequent in patients with a good outcome than in those who collapsed without a witness (91% vs 75%, p = 0.03). In 76% of the patients with good outcome, CPR was performed whereas only 52% benefited from these measures in the bad outcome group (p = 0.01). Although the use of an AED was not significantly different between good and bad outcome groups (26% vs. 11%, p = 0.06), time to first defibrillation was significantly lower in patients with good outcome (8.7 +/- 6.3 vs. 13.3 +/- 11.3 minutes, p = 0.05). In the 17 patients in whom an AED was used, 12 (71%) recovered without major sequelae whereas in the 73 cases where no AED was used, only 34 (47%) had a good outcome (p = 0.06). At 6 months follow-up, 46 (51%) survivors had a good outcome (cerebral performance category 1-2), 5 (6%) survived with severe neurological sequelae or stayed in coma and 39 (43%) died.

Conclusions: Our local data confirm that early interventions have a major impact on survival of cardiac arrest patients. Efforts should concentrate on delivering rapid and high quality CPR as well as early defibrillation by AED's to every patient in cardiac arrest. Besides large scale Basic life support training, the introduction of dispatcher assisted CPR and the implementation and use of public AED's could considerably help to improve outcome in these patients.

This review will mainly focus the last 10 years of the society's history because several important changes occurred during this relatively short period. The most important was the creation of the first clinical sports medicine department in Luxembourg in 2004. This modern new infrastructure was made possible by the recruitment of 2 highly competent sports physicians, the excellent collaboration of the governing board of the Centre Hospitalier de Luxembourg (CHL) and the support of the sports minister. In 2008 the new department received the label "Medical Olympic Centre of Luxembourg". One year later a Research Lab of Sports Medicine (CRP-Santé) completed the new concept. Thus within 4 years the structure of Luxembourgish sports medicine was completely rearranged and includes today orthopaedic surgery and traumatology, functional rehabilitation, sports cardiology, exercise physiology, physiotherapy and specific sports medicine research. An important new challenge of the SLMS will be to integrate the external sports physicians into this new infrastructure. Another ongoing mission of the SLMS will be the education and training of new young sports medicine specialists. Here the new department could play an outstanding role and the SLMS is in close negotiations with the University of Luxembourg, in charge of academic education in Luxembourg. A recruitment of new young sports physicians is necessary to perpetuate the routine sports medicine exams in the 15 regional centres in Luxembourg, where such an exam is mandatory in order to get an official sports licence. Since 2010 an ECG exam has been added for all new licence candidates, according to the recent recommendations of the scientific societies. New young sports physicians will also be needed to assure the medical attendance of the different national teams of Luxembourg. Until 1985 these activities were confined only to the Olympic teams every 4 years, but since the implementation of the Games of the Small European Countries in 1985, where rather big teams represent Luxembourg every two years, this mission has become more important. The history of the SLMS reflects the development both of sports and sports medicine during the last 60 years. At the beginning of the 21.century sports medicine is well settled in the Grand-duchy of Luxembourg.

In the case of early ovary extinction, the only way to have a child is either adoption or egg/embryo reception by donation. To day, egg donation is prohibited in Luxembourg by ministerial decision in 2003. Germ cell donation is part of artificial reproductive therapy. Oocyte donation, in particular, needs to be done by IVF treatment, which makes it more complicated then sperm donation What makes it more difficult is the fact that there are no oocyte bank yet. Today, prohibition encourages procreative tourism what only wealthy people can afford. Although donation programs are well established many questions arise about egg donation such as refunds, divulging information, women's age limit, health insurance participation.

Objective: Assess the impact of the reduction or loss of autonomy of the elderly in the nosocomial infection risk.

Method: Using Karnosfsky scale (KPS). This study involved 163 patients aged 65 and over hospitalized for medical reasons.

Data collection: KPS index, body mass index, Index Norton, bladder's drainage system at the entrance and during hospitalization, colonization of resistant bacteria (BMR) at entry and during hospitalization, antibiotic use at entry and during hospitalization, infection at entry and during hospitalization.

Results: There is a statistically significant relationship between the degree of autonomy and the index of risk of pressure ulcers (Norton), between the degree of autonomy and the use of bladder's drainage system, between the degree of autonomy and risk acquisition of BMR, between the degree of autonomy and the nosocomial infection risk.

Conclusion: The level of dependence increases the risk of infection nosocomial: loss of autonomy is a risk factor for infection. The evaluation of the degree o autonomy of elderly patients at entry and at regular intervals is essential in ou view a policy of reducing nosocomial infections.

Postoperative deformities of the knee and sequaelae after intraarticular surgery can interfere with a standard parapetallar approach for intramedullary stabilisation of the tibia. Even the suprapatellar approach can be rendered impossible. For these rare indications we describe the patella osteotomy and transpatellar approach.