Oeuvres patriotiques de Voltaire, Catherine la Grande et le Grand Frédéric, suivies des trois héroïnes de France [Jeanne d'Arc, Melle Philis de la Charce de la Tour-du-Pin et Jeanne Hachette]

Comprend : [Lettres de Voltaire

L'assemblée générale de tous les Français au Champ-de-Mars, pour le pacte fédératif du 14 juillet, ou La grande confédération nationale ([Reprod.])

Collection : Les archives de la Révolution française ; 6.2.1109

[Voyage en Italie : 1824-1830]. , Charpente de la grande salle du vieux palais ; charpente du nouveau theâtre de Prato : [élévations d'une ferme et sous-face d'un entrait pour chacune des deux charpentes] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 147

[Voyage en Italie : 1824-1830]. , [Palazzo Pretorio et église San Lorenzo sur la grande place] : [plan d'ensemble] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 107

Perforation colique néonatale focale spontanée en dehors de la grande prématurité : rare et potentiellement insidieuse [Focal spontaneous colic perforation in term or near-term neonates: rare and potentially insidious].

Two cases of neonatal focal spontaneous colic perforations are reported. The 1st infant, born at 36 3/7 weeks gestational age, presented on day 3 with crying, abdominal distension, and liquid stools. Clinical examination showed a slightly irritable hypothermic (35.7 °C) infant with a distended abdomen and few bowel sounds. Blood tests were normal apart from an elevated C-reactive protein level (59 mg/l). The abdomen x-ray was erroneously considered normal. The infant's condition remained stable for nearly 3 days. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was started on antibiotics and operated. Macroscopically, the entire gut was normal apart from a focal sigmoid perforation, which was stitched. A transmural colic biopsy revealed focal vascular dilation but was negative for necrotising enterocolitis or Hirschsprung disease. The infant recovered quickly. She is now a healthy, normal 3-year-old. The 2nd infant, born at 38 5/7 weeks gestational age, presented between day 1 and 2 with clinical signs of infection associated with slowly progressive ileus. The chest and abdomen x-ray was mistakenly considered normal. Frank septicemia developed. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was operated. Macroscopically, the small intestine was normal, the ascending and transverse colons were dilated, and the descending and sigmoid colons were narrow. Three cecal perforations were discovered and stitched. An ileostomy and multiple colic biopsies were also performed. The postoperative course was complicated by persistent septic ileus due to descending and sigmoid colon leaks, which led to colic resections with end-to-end anastomosis. Rectal aspiration biopsies were also performed. At 1 month of age, the infant was discharged from the hospital. The ileostomy was closed in two steps at 2 and 5 months of age. A normal sweat test excluded cystic fibrosis. All colic and rectal biopsies revealed nonspecific inflammatory signs and excluded necrotizing enterocolitis and Hirschsprung disease. Nonspecific irregular thinning of muscularis mucosae and muscularis propria were observed in the two resected colic segments. The boy is now a healthy 7-year-old. The incidence of neonatal focal spontaneous colic perforations at term or close to term is unknown but probably very rare. Our department is the neonatal referral center for approximately 14,000 annual births. In the last 10 years (2000-2009), out of 5115 neonatal admissions in our unit, only ten cases have presented a neonatal spontaneous intestinal perforation, seven of ten in very-low-birth-weight infants and three of ten in term or near-term neonates (one with Hirschsprung disease and the two cases reported herein). In the same period, 108 infants suffered from necrotizing enterocolitis, seven of 108 were term infants and 6 out of 7 had a congenital heart disease. The medical literature is poor on the subject of focal spontaneous colic perforations at term; no risk factor is described. The most specific clinical sign seems to be the abdominal distension. The presence of pneumoperitoneum on an abdominal x-ray is the most sensitive paraclinical sign. In case of an intestinal perforation, surgery must be performed quickly. The vital prognosis seems to be good. The objective of this study was to draw pediatricians' attention to focal spontaneous colic perforations in term or close to term newborns. In the cases reported, the diagnostic delays could have been prevented if the entity - with its radiological manifestation - had been well known.

Implantación de buenas prácticas en la residencia Nord Egara de Castellar del Vallés (Barcelona)

Este trabajo está basado en las prácticas del trabajo final de máster (TFM) de “Envejecimiento Activo y Satisfactorio” de la Universidad de Vic. Partiendo de la base que según la OMS el Envejecimiento Activo (en adelante EA) “pretende optimizar las oportunidades de salud, participación y seguridad a fin de mejorar la calidad de vida de las personas mayores”, en la Residencia Nord Egara de Castellar del Vallés (Barcelona) promoví un conjunto de Buenas Prácticas (en adelante BBPP), centrando la atención en los usuarios y considerando las dificultades derivadas de su situación de fragilidad y/o dependencia. En el Centro se promovieron dos tipos de BBPP: 7 BBPP de mejora enfocadas a las intervenciones en el Centro y 3 BBPP de recomendaciones para la buena praxis profesional en la vida cotidiana. La implantación de las BBPP implicó repensar en el ámbito organizativo y relacional del Centro, mejorando, entre otros aspectos, la manera de actuar de los profesionales, aspectos de organización interna, ampliación de horarios profesionales y las formas cotidianas de relación interpersonal. En concreto, las BBPP de mejora reportaron avances tales como ofrecer la oportunidad para que los usuarios, en función de sus capacidades y deseos, pudieran elegir entre varias alternativas, implicar a los usuarios y/o familias en las tomas de decisiones sobre aspectos que conciernen a la vida del propio usuario, aumentar la relación de los usuarios con el exterior (tanto abriendo el Centro a la comunidad como aumentando la integración de los usuarios en el entorno) y aumentar la implicación de las familias de los usuarios en la vida del Centro. Por otra parte, las BBPP como recomendaciones sirvieron de complemento para que los profesionales se evaluaran y reflexionaran sobre sus formas de actuación y de relación, concretando cómo debería actuar el equipo profesional si quería seguir avanzando, después de mi intervención en el Centro, en las áreas de mejora tratadas con las BBPP desarrolladas. Al finalizar el presente TFM, el Centro estaba en pleno proceso de implantación de prácticamente todas las BBPP. Por este motivo, con el paso de los meses, el equipo tendrá que ir revisando, evaluando y modificando (si precisa) dichas BBPP. A pesar de no estar todas completamente implantadas, éstas ya han dejado constancia de mejoras y beneficios en la calidad de vida de los usuarios.