Rééducation vasculaire du patient artériopathe [Vascular rehabilitation of patients suffering from peripheral arterial disease].

Rehabilitation programs represent an important and valuable tool for patients suffering various diseases. Supervised exercise programs for patients with peripheral arterial diseases have been shown to be efficacious in ameliorating walking performances and quality of life of such patients. With this regards the angiology service of the CHUV in Lausanne has established a multidisciplinary supervised program of vascular rehabilitation. This article describes organisation and characteristics of such a program.

Consultation pluridisciplinaire "Souffrance au travail": une expérience romande [Multidisciplinary consultation "Suffering at work": an experience in western Switzerland].

Les problèmes de santé mentale au travail constituent un défi à la fois clinique, professionnel, économique et de santé publique. Les coûts totaux qu'ils génèrent en Suisse équivalent à 3,2 % du produit intérieur brut (PIB) suisse et ils aboutissent très souvent à un licenciement. La grande majorité des personnes sont soignées par un médecin de premier recours. L'Institut de Santé au Travail propose une consultation spécialisée dans les questions de souffrance au travail, offrant aux soignants de première ligne un avis ou un soutien pluridisciplinaire, dans une perspective collaborative des soins. Son action, adaptée aux besoins de chaque situation, va d'un avis à une orientation vers des spécialistes pouvant étoffer durablement le réseau (suivi psychiatrique, programme de soutien à l'emploi, avis juridique ou social). Mental health problems at work constitute a challenge in the clinical feld, as well in the professional, the economic and the public health perspective. The total costs they generate in Switzerland are equivalent to 3.2% of the Swiss gross domestic product and they very often lead to dismissal. The vast majority of people are treated by their primary care physician. The Institute for Work and Health features a specialized consultation on the topic of suffering at work, offering the primary care physicians a pluridisciplinary advice or support, in a collaborative care prospect. Its action, adapted to each situation's needs, goes from an advice to a referral to specialists that can strengthen the network on a long-term basis (mental health follow-up, supported employment program, legal or social advice).

Como si fuera posible recoger sentimientos = As if it were possible to collect suffering

Se trata de una propuesta como resultado del trabajo conjunto entre la escuela de Arte Pigment y el ESPAI ZERO1 del Museu Comarcal de la Garrotxa, destinado exclusivamente a exposiciones temporales de creación contemporánea y como continuidad de propuestas anteriores de colaboración: REPLICA23 y SONESNAT JUNIOR. Com si fos possible recollir el sofriment es un proyecto de la artista Anna Manel.la, y se consideró una propuesta interesante y un reto para conversar, intercambiar y crear con los alumnos sobre el tema de la exposición: la muerte y el sufrimiento. Asimismo porque es una artista conocida por los alumnos de la escuela Pigment, ya que anteriormente habían realizado un proyecto de apadrinamiento de esculturas y habitualmente ella participa en programas divulgativos en la escuela. El trabajo desarrollado centra el aprendizaje en la creación y en la investigación artística como ejes de los procesos de conceptualización con el objetivo de atender las dinámicas y los estímulos característicos de los niños. Facilitando procesos de búsqueda, exploración y manipulación sin condicionantes y promoviendo procesos autónomos en los que los mismos niños se planteen dudas e interrogantes y se enfrenten a situaciones cada vez mas complejas

The effect of bacterial lipopolysaccharide on gastric emptying in rats suffering from moderate renal insufficiency

The objective of the present study was to evaluate the response of rats suffering from moderate renal insufficiency to bacterial lipopolysaccharide (LPS, or endotoxin). The study involved 48 eight-week-old male SPF Wistar rats (175-220 g) divided into two groups of 24 animals each. One group underwent 5/6 nephrectomy while the other was sham-operated. Two weeks after surgery, the animals were further divided into two subgroups of 12 animals each and were fasted for 20 h but with access to water ad libitum. One nephrectomized and one sham-treated subgroup received E. coli LPS (25 µg/kg, iv) while the other received a sterile, pyrogen-free saline solution. Gastric retention (GR) was determined 10 min after the orogastric infusion of a standard saline test meal labeled with phenol red (6 mg/dl). The gastric emptying of the saline test meal was studied after 2 h. Renal function was evaluated by measuring the plasma levels of urea and creatinine. The levels of urea and creatinine in 5/6 nephrectomized animals were two-fold higher than those observed in the sham-operated rats. Although renal insufficiency did not change gastric emptying (median %GR = 26.6 for the nephrectomized subgroup and 29.3 for the sham subgroup), LPS significantly retarded the gastric emptying of the sham and nephretomized groups (median %GR = 42.0 and 61.0, respectively), and was significantly greater (P<0.01) in the nephrectomized rats. We conclude that gastric emptying in animals suffering from moderate renal insufficiency is more sensitive to the action of LPS than in sham animals

Immune and hormonal activity in adults suffering from depression

An association between depression and altered immune and hormonal systems has been suggested by the results of many studies. In the present study we carried out immune and hormonal measurements in 40 non-medicated, ambulatory adult patients with depression determined by CID-10 criteria and compared with 34 healthy nondepressed subjects. The severity of the condition was determined with the Hamilton Depression Rating Scale. Of 40 depressed patients, 31 had very severe and 9 severe or moderate depression, 29 (72.5%) were females and 11 (27.5%) were males (2.6:1 ratio). The results revealed a significant reduction of albumin and elevation of alpha-1, alpha-2 and ß-globulins, and soluble IL-2 receptor in patients with depression compared to the values obtained for nondepressed subjects (P<0.05). The decrease lymphocyte proliferation in response to a mitogen was significantly lower in severely or moderately depressed patients when compared to control (P<0.05). These data confirm the immunological disturbance of acute phase proteins and cellular immune response in patients with depression. Other results may be explained by a variety of interacting factors such as number of patients, age, sex, and the nature, severity and/or duration of depression. Thus, the data obtained should be interpreted with caution and the precise clinical relevance of these findings requires further investigation.

Narrative of the suffering and defeat, of the North-Western Army under General Winchester : massacre of the prisoners, sixteen months imprisonment of the writer and others with the Indians and British

Printed by A.G. Hodges

Encountering the suffering other in illness narratives : between the memory of suffering and the suffering memory

Cette étude porte sur la dimension intersubjective de la souffrance qui affecte le rapport du souffrant à son corps, au temps et à l’espace vécus de même que son identité narrative et sa mémoire narrative. Mon argument principal est que la voix narrative constitue le rapport intersubjectif dans les récits de maladie que les proches écrivent sur leurs partenaires souffrant de cancer de cerveau ou de la maladie d’Alzheimer. Ma discussion est basée sur l’éthique, la phénoménologie, les théories de l’incorporation, les études des récits de vie, la sociologie et l’anthropologie médicales et la narratologie. L’objet de mon étude est l’expérience incorporée de la souffrance dans les récits de maladie et je me concentre sur la souffrance comme perte de la mémoire et du soi narratif. J’analyse le journal How Linda Died de Frank Davey et les mémoires de John Bayley, Iris: A Memoir of Iris Murdoch et Iris and Her Friends: A Memoir of Memory and Desire. J’explore comment les récits de maladie constituent le rapport éthique à l’Autre souffrant de la rupture de la mémoire. La discussion de la voix est située dans le contexte des récits de vie et se propose de dépasser les limites des approches sociologiques et anthropologiques de la voix dans les récits de maladie. Dans ce sens, dans un premier temps je porte mon attention sur des études narratologiques de la voix en indiquant leurs limites. Ma propre définition de la voix narrative est basée sur l’éthique dans la perspective d’Emmanuel Levinas et de Paul Ricœur, sur l’interprétation du temps, de la mémoire et de l’oubli chez St-Augustin et la discussion levinasienne de la constitution intersubjective du temps. J’avance l’idée que la “spontanéité bienveillante” (Ricœur, Soi-même comme un autre 222) articule la voix narrative et l’attention envers l’Autre souffrant qui ne peut plus se rappeler, ni raconter sa mémoire. En reformulant la définition augustinienne du temps qui met en corrélation les modes temporels avec la voix qui récite, j’avance l’idée que la voix est distendue entre la voix présente de la voix présente, la voix présente de la voix passée, la voix présente de la voix future. Je montre comment la voix du soignant est inscrite par et s’inscrit dans les interstices d’une voix interrompue, souffrante. Je définis les récits de vies comme des interfaces textuelles entre le soi et l’Autre, entre la voix du soi et la voix du souffrant, comme un mode de restaurer l’intégrité narrative de l’Autre.

Managing Profound Suffering at the End-of-Life: Should expanding access to continuous deep sedation be the priority?

Commentaire / Commentary

Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis

Objectives: Does artichoke leaf extract (ALE) ameliorate symptoms of Irritable bowel syndrome (IBS) in otherwise healthy volunteers suffering concomitant dyspepsia? Methods: A subset analysis of a previous dose-ranging, open, postal study, in adults suffering dyspepsia. Two hundred and eight (208) adults were identified post hoc as suffering with IBS. IBS incidence, self-reported usual bowel pattern, and the Nepean Dyspepsia Index (NDI) were compared before and after a 2-month intervention period. Results: There was a significant fall in IBS incidence of 26.4% (p<0.001) after treatment. A significant shift in self-reported usual bowel pattern away from "alternating constipation/diarrhea" toward "normal" (p<0.001) was observed. NDI total symptom score significantly decreased by 41% (p<0.001) after treatment. Similarly, there was a significant 20% improvement in the NDI total quality-of-life (QOL) score in the subset after treatment. Conclusion: This report supports previous findings that ALE ameliorates symptoms of IBS, plus improves health-related QOL.

Elevated levels of corticotrophin-releasing factor binding protein in the blood of patients suffering from arthritis and septicaemia and the presence of novel ligands in synovial fluid.

In view of the reported inflammatory effects of corticotrophin-releasing factor (CRF) and the associated regulatory elements in the gene of its binding protein (BP), we postulate that both BP as well as novel BP-ligands other than CRF may be involved in inflammatory disease. We have investigated BP in the blood of patients with arthritis and septicaemia and have attempted to identify CRF and other BP-ligands in synovial fluid. The BP was found to be significantly elevated in the blood of patients with rheumatoid arthritis and septicaemia. There was less BP-ligand and CRF in synovial fluid from patients with rheumatoid arthritis that from those with osteo- or psoriatic arthritis. There was at least 10-fold more BP-ligand than CRF in the fluid of all three groups of patients. A small amount of immunoreactive human (h)CRF, eluting in the expected position of CRF-41, was detected after high-pressure liquid chromatography of arthritic synovial fluid; however, the bulk of material with BP-ligand binding activity eluted earlier, suggesting that synovial fluid contained novel peptides that interacted with the BP. These results would suggest that the BP and its ligands could play an endocrine immunomodulatory role in inflammatory disease.