Prise en charge du traumatisme cranio-cérébral sévère [Update on the management of severe traumatic brain injury]

Prognosis after severe traumatic brain injury (TBI) is determined by the severity of initial injury and secondary cerebral damage. The main determinants of secondary cerebral damage are brain ischemia and oedema. Traumatic brain injury is a heterogeneous disease. Head CT-scan is essential in evaluating initial type of injury and severity of brain oedema. A standardised approach based on prevention and treatment of secondary cerebral damage is the only effective therapeutic strategy of severe TBI. We review the classification, pathophysiology and treatment of secondary cerebral damage after severe TBI and discuss the management of intracranial hypertension, cerebral perfusion pressure and brain ischemia.

Dépistage des cancers en pratique clinique: une place privilégiée pour le partage de la décision. [Cancer screening in clinical practice: the value of shared decision-making]

Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making. L'incertitude quant à l'efficacité de certains dépistages de cancers et du traitement en cas de test positif rend l'application du partage de la décision particulièrement appropriée. Le concept du partage de la décision peut être défini comme un processus interactif où le médecin et le patient partagent les étapes du processus de décision. Face aux patients qui désirent être impliqués dans les décisions concernant leur santé, les médecins peinent parfois à le faire. Or, l'utilisation d'outils d'aide à la décision est un moyen efficace de favoriser ce partage de l'information et, si souhaité par le patient, de la décision.

Prise en charge de l'asthme en médecine de premier recours [Management of asthma in primary care medicine].

The international recommendations issued by GINA (Global Initiative for Asthma) have undergone considerable adaptations over the last years. This article proposes the local adaptation of those guidelines bearing on the practical aspects of the treatment for the general practitioner's use. One of the fundamental changes in these new guidelines on good practice relates to the permanent adaptation of the treatment on the basis of symptom control rather than on the severity of the asthma. Another change from the old recommendations concerns the manner in which the asthma is categorised into different phases.

Collective states of 3He clusters

The monopole (L=0) and quadrupole (L=2) strength distributions in normal 3He clusters are calculated within the random-phase approximation. We use a phenomenological, zero-range 3-3He interaction to generate the Hartree-Fock single-particle spectrum and the residual particle-hole interaction. The evolution of the collective modes with the number of atoms in the cluster is discussed.

Prise en charge initiate du sepsis sévère et du choc septique [Management of severe sepsis and septic shock].

Severe sepsis and septic shock are systemic manifestations of the host response to infection. Mortality remains high despite advances in pathophysiological knowledge. Hemodynamic and respiratory management is largely supportive, while early antibiotics administration and source of infection's control are crucial for patient outcome. We review the principles guiding the initial management of these patients in emergency situation.

Collective and single-particle excitations of a trapped Bose gas

The density of states of a Bose-condensed gas confined in a harmonic trap is investigated. The predictions of Bogoliubov theory are compared with those of Hartree-Fock theory and of the hydrodynamic model. We show that the Hartree-Fock scheme provides an excellent description of the excitation spectrum in a wide range of energy, revealing a major role played by single-particle excitations in these confined systems. The crossover from the hydrodynamic regime, holding at low energies, to the independent-particle regime is explicitly explored by studying the frequency of the surface mode as a function of their angular momentum. The applicability of the semiclassical approximation for the excited states is also discussed. We show that the semiclassical approach provides simple and accurate formulas for the density of states and the quantum depletion of the condensate.

Temperature-induced resonances and Landau damping of collective modes in Bose-Einstein condensed gases in spherical traps

Interaction between collective monopole oscillations of a trapped Bose-Einstein condensate and thermal excitations is investigated by means of perturbation theory. We assume spherical symmetry to calculate the matrix elements by solving the linearized Gross-Pitaevskii equations. We use them to study the resonances of the condensate induced by temperature when an external perturbation of the trapping frequency is applied and to calculate the Landau damping of the oscillations.

Polyarthrite rhumatoïde du sujet agé: présentation clinique et prise en charge [Late-onset rheumatoid arthritis: clinical presentation and management]

Onset of rheumatoid arthritis in an elderly patient is common, in fact more common than in younger subject. If the reality of true differences in clinical presentation between younger and older subjects remained discussed, the central point remains that the prognosis is not better in older patients. Finally, conventional disease-modifying antirheumatic drugs (DMARD) and biological treatments are as efficient and safe than in younger patients, and the same strict management objectives used for younger subjects must be applied in the elderly.