Evaluation de deux structures à bas seuil de la ville de Lausanne : Le Passage et le Point d'eau

[Table des matières] 1. Méthodes d'évaluation. 2. Le Passage et le Point d'eau. 2.1. Historique et objectifs. 2.2. Etapes de la mise en route. 3.1. Professionnels salariés. 3.2. Bénévoles professionnels. 3.3. Bénévoles d'accueil. 4.1. Activités de la structure. 4.2. Accueil (animations, repas, collations). 4.3. L'offre socio-éducative. 4.4. L'offre sanitaire. 4.5. La distribution du matériel stérile. 5.1. Prestations d'hygiène. 5.2. Soins somatiques. 5.3. Activité sportive. 6.1. Profil des usagers. 6.2. Indicateurs socio-démographiques et d'intégration sociale. 6.3. Etat de santé perçu. 6.4. Fréquentation du réseau (dispositif bas seuil et autre) et de Point d'eau. 7. Consommation de drogues illégales. 8. Fréquentation de la structure. 9.1. Méthodes d'évaluation utilisées. 9.2. Evaluation du Passage et du Point d'eau.

Telomere fluorescence measurements in granulocytes and T lymphocyte subsets point to a high turnover of hematopoietic stem cells and memory T cells in early childhood.

To study telomere length dynamics in hematopoietic cells with age, we analyzed the average length of telomere repeat sequences in diverse populations of nucleated blood cells. More than 500 individuals ranging in age from 0 to 90 yr, including 36 pairs of monozygous and dizygotic twins, were analyzed using quantitative fluorescence in situ hybridization and flow cytometry. Granulocytes and naive T cells showed a parallel biphasic decline in telomere length with age that most likely reflected accumulated cell divisions in the common precursors of both cell types: hematopoietic stem cells. Telomere loss was very rapid in the first year, and continued for more than eight decades at a 30-fold lower rate. Memory T cells also showed an initial rapid decline in telomere length with age. However, in contrast to naive T cells, this decline continued for several years, and in older individuals lymphocytes typically had shorter telomeres than did granulocytes. Our findings point to a dramatic decline in stem cell turnover in early childhood and support the notion that cell divisions in hematopoietic stem cells and T cells result in loss of telomeric DNA.

Infections pulmonaires : le point de vue du radiologue [Pulmonary infections: the radiologist's point of view]

La place de l'imagerie est essentielle au cours des infections pulmonaires. La TDM doit être effectuée en cas de forte suspicion clinique de pneumonie avec aspect radiographique normal, équivoque ou non spécifique, ce qui concerne particulièrement les sujets immunodéprimés. Elle permet de détecter les anomalies associées ou une affection sous-jacente, d'orienter un lavage broncho-alvéolaire ou de guider une biopsie pulmonaire percutanée ou transbronchique. Les expressions d'un germe peuvent varier selon le degré d'immunodépression. Il en est ainsi pour la tuberculose au cours du sida. Les germes impliqués varient selon le type d'immunodépression, certaines infections pouvant engager rapidement le pronostic vital. Le spectre radiologique de l'aspergillose pulmonaire, complexe, doit être connu, ce diagnostic devant être proposé dans des conditions particulières.

Mise au point concernantl'utilisation du dosagede l'antigène carcino-embryonnaire (CEA)en clinique

The carcinoembryonic antigen (CEA) is a tumor marker defined by specific heterologous antisera. Elevated levels of circulating CEA have been detected by radioimmunoassay in 20-90 per cent of cases of colorectal carcinomas depending on the degree of tumor spread. The fact that elevation of CEA level can also be observed in other types of carcinomas and in several non malignant conditions greatly limit the value of the CEA test for the early diagnosis of colorectal carcinoma. Thus, the CEA assay should not be used as a screening test for cancer. Repeatecl CEA mesurements, however, appear to be of importance for the evaluation of tumor resection and the detection of tumor recurrence. The only localized tumors known to produce elevation of CEA above the levels observed in non malignant diseases are carcinomas of the large bowel and the pancreas. In carcinomas derived from other organs a marked increase of CEA level is always associated with the presence of distant metastasis. Therefore at the present time the clinical applications of the CEA radioimmunoassay should be limited to the differentiai diagnosis of patients with suspicion of primary colorectal or pancreatic carcinoma, to the detection of distant metastasis in other types of carcinomas and to the post operative follow up of patients who had elevated levels of CEA before surgery. Well-controlled studies are still needed to determine if therapeutic decisions based on CEA results can lead to improved survival.

Oral flurbiprofen metabolic ratio assessment using a single-point dried blood spot.

We investigated whether a single blood measurement using the minimally invasive technique of a finger prick to draw a blood sample of 5 µl (to yield a dried blood spot (DBS)) is suitable for the assessment of flurbiprofen (FLB) metabolic ratio (MR). Ten healthy volunteers who had been genotyped for CYP2C9 were recruited as subjects. They received FLB alone in session 1 and FLB with fluconazole in session 2. In session 3, the subjects were pretreated for 4 days with rifampicin and received FLB with the last dose of rifampicin on day 5. Plasma and DBS samples were obtained between 0 and 8 h after FLB administration, and urine was collected during the 8 h after administration. The pharmacokinetic profiles of the drugs were comparable in DBS and plasma. FLB's apparent clearance values decreased by 35% in plasma and DBS during session 2 and increased by 75% in plasma and by 30% in DBS during session 3. Good correlations were observed between MRs calculated from urine, plasma, and DBS samples.

Représentations sociales et représentations intimes de la maladie. Quelques réflexions d'un clinicien [Social and private representations of cancer. A clinician's point of view]

This paper discusses social representations in scientific communications and private ones that are linked to the individual imagination. Social representations, in a limited sense, are useful for the development of preventive messages, but of little benefit to clinical work. We highlight some non-explicit aspects of scientific discourse that impact on treatment: projected beliefs and values. We tackle the relationship between the concepts of representation, imagination, identity and temporality in the individual approach of the cancer patient.

Monsieur le Minotaure et son point de vue

Les visions hallucinées de Friedrich Dürrenmatt, l'un des plus importants écrivains suisses de l'après-guerre, au travers des dessins et des manuscrits consacrés aux mythes de la Pythie, du Minotaure et de Midas. L'itinéraire créatif de Friedrich Dürrenmatt, outre sa production littéraire bien connue, est constellé d'une intense activité de peintre, de dessinateur et de graveur sur cuivre, activité qui délimite un important terrain de confrontation des pensées et des thèmes caractérisant sa recherche. Ce volume, qui accompagne l'exposition organisée par le célèbre architecte tessinois Mario Botta, présente une sélection de dessins et de notes de voyage appartenant à la collection privée de Charlotte Kerr-Dürrenmatt. Ceux-ci ont trait aux mythes de la Pythie, du Minotaure et de Midas, auxquels Dürrenmatt a consacré tant de réflexions. Les thèmes de la mythologie grecque ont toujours été présents dans la recherche de l'auteur sur la condition humaine, au point qu'il en est parfois arrivé à se représenter, de manière autobiographique, comme le protagoniste des événements décrits. Ces oeuvres revêtent une importance fondamentale car elles mettent en valeur l'importance et la signification que l'écrivain attribue à cette activité, considérée comme " mineure " par la critique mais qu'il faut en revanche interpréter comme un complément important des métaphores écrites auxquelles renvoie toute sa pensée.

Endocardite infectieuse: mise au point [Infective endocarditis: update]

The pathogenesis of infective endocarditis (IE) is being dissected at the molecular level, which should help redefine new preventive and therapeutic strategies against IE. In spite of improving health care, the incidence of IE has not decreased over the last decades. While classical predisposing conditions such as rheumatic heart disease were being eradicated, new features of IE have emerged. These include IE in intravenous drug users, IE in elderly patients with sclerotic valve disease, prosthetic valve IE and nosocomial IE. The epidemiology, pathogenesis, diagnosis, prevention and treatment of IE are being reviewed in this article.