P. Durasnel - Academia.edu (original) (raw)
Papers by P. Durasnel
Bulletin de la Société de pathologie exotique, 2013
In Africa the destruction of the urethra is the most severe complication of pregnancy-related ves... more In Africa the destruction of the urethra is the most severe complication of pregnancy-related vesico-vaginal fistula. The authors report their experiences treating such conditions using an original procedure to reconstruct the urethra with the aid of a pedunculated skin flap raised from the labia majora. 35 cases of destroyed urethras treated using this approach between January 1992 and June 1996 in the Urology Department of the National Hospital of Niamey in Niger are reviewed. All patients were Black of mean age 18 years with a mean follow-up period of 19 months. The women ranged in age from 13 to 31 years old. An extension plasty technique was used in 16 cases and tubulization in 19 cases. The repair of urinary incontinence was achieved using a suburethral loop system created using a fatty flap taken from the labia majora. Urethro-cervico-suspension of the vagina was needed in 6 cases. Normal micturition with no leakage was achieved in 24 cases (68.6%) and there was functional im...
Bulletin de la Société de pathologie exotique, 2014
En 2012, 22,6 millions d'enfants dans le monde ne bénéficiaient toujours pas des vaccins de base.... more En 2012, 22,6 millions d'enfants dans le monde ne bénéficiaient toujours pas des vaccins de base. Le Plan d'Action mondial pour les Vaccins (Global Vaccine Action Plan-GVAP) 2011-2020 a une mission simple : améliorer la santé en étendant tous les avantages de la vaccination à tous les individus, quel que soit l'endroit où ils sont nés, qui ils sont et où ils vivent, d'ici 2020. Pour mettre en oeuvre le GVAP, il faut : • des financements : l'Alliance GAVI lancée en 2000 apporte un appui financier pour les vaccins dans les pays à revenu faible ou intermédiaire (PRF-PRI) ; • la sécurité des vaccins : rôle du Comité consultatif mondial de la sécurité vaccinale (Global Advisory Committee on Vaccine Safety-GACVS), crée en 1999 ; • une expertise : le Groupe stratégique consultatif d'experts (SAGE) sur les vaccinations créé en 1999 formule des recommandations sur les travaux du Département vaccination, vaccins et produits biologiques de l'OMS. Dans le cadre des Avancées vaccinales en 2012-2013 dans les PFR-PRI, nous étudierons les maladies évitables par la vaccination qui sont en voie d'élimination, les nouveaux vaccins, les vaccins en attente et les vaccins faisant l'objet de doutes sur leur sécurité. Entre 2000 et 2012, le nombre de cas de rougeole notifiés dans le monde a baissé de 73 %. En 2012, toutes les Régions
Médecine …, 2005
... P. DURASNEL, P. GALLET DE SANTERRE, D. MERZOUKI, M. RIDHOINE, M. CHARIF, A. DADA, FM LAHAYE .... more ... P. DURASNEL, P. GALLET DE SANTERRE, D. MERZOUKI, M. RIDHOINE, M. CHARIF, A. DADA, FM LAHAYE ... Le jeune âge des pat ients , le cara ct è re aigu et la réve rsibilité des affe ctions rencontrées expliquent ces « bons » résultats. ...
Medecine tropicale : revue du Corps de sante colonial, 2005
The purpose of this monocentric prospective cohort study was to assess mortality in intensive car... more The purpose of this monocentric prospective cohort study was to assess mortality in intensive care unit (ICU) patients requiring more than 6 hours of mechanical ventilation (MV) in a developing country. The study setting was a 10-bed polyvalent ICU at the Centre Hospitalier Régiona1 in El Maarouf, Comoros Islands. The study population included a total of 106 patients requiring MV out of 633 consecutive patients admitted to the ICU over a 10-month period. Study parameters included demographic data, simplified acute physiology score version 2 (SAPS II), reason for admission, urgency of MV, duration of MV, complications of MV need for sedation and mortality in hospital and at one year. In-hospital mortality was 59%. Mortality was significantly higher in patients presenting elevated SAPS II and requiring myorelaxant drugs. Age, gender, reason of admission, emergency, sedation, complications of MV, duration of MV were not correlated with mortality. The best prognosis was associated with ...
La destruction de l'uretre feminin, peu courante en Europe, est, en Afrique noire, la complic... more La destruction de l'uretre feminin, peu courante en Europe, est, en Afrique noire, la complication la plus severe des fistules vesico-vaginales d'origine obstetricale. Nous rapportons notre experience du traitement de ces destructions de l'uretre selon un procede original de reconstruction uretrale a l'aide d'un lambeau cutane pedicule preleve au niveau de la grande levre. Trente-cinq cas de destructions uretrales traitees par uretroplastie labiale pediculee entre janvier 1992 et juin 1996 dans le Service d'Urologie de l'Hopital National de Niamey, au Niger, ont ete analyses. Ces lesions concernaient des femmes de race noire dont l'âge moyen etait de 18 ans avec une mediane de recul de 19 mois. Deux variantes techniques ont ete realisees et sont decrites dans ce travail, la plastie d'allongement (16 cas) et la plastie tubulee de remplacement (19 cas). Le traitement de l'incontinence urinaire a ete assure par un systeme de fronde sous-uretrale ...
Médecine et Maladies Infectieuses
Bulletin de la société de pathologie exotique
Médecine et Maladies Infectieuses
Médecine et santé tropicales
Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have... more Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have largely completed their demographic and epidemiologic transitions. Major investments in infrastructure and social services have fostered steady economic growth. Health care and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population nonetheless present significant challenges for public health and the health system. Like the other small island states in the region, the Seychelles continue to be threatened by arbovirus outbreaks. Health indicators are good, but the geographic isolation, the small and aging population, and limited resources make a major challenge maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform, and increasing amount of medications particularly in view of the increasing burden of chronic diseases.
Annales de cardiologie et d'angéiologie, 2005
A consecutive cohort including 1080 patients undergoing "off-pump" myocardial revascula... more A consecutive cohort including 1080 patients undergoing "off-pump" myocardial revascularization was reviewed. An average of 2.22 bypass/patients was performed. The death-rate during the first 30 days after surgery was 0.65%. Four cases needed cross-over to on-pump. The postoperative events were: need of inotropic drugs (2.7%), atrial fibrillation (12.4%), myocardial infarction (6.6%). The extubation was performed before the first postoperative 24 h in 91.9% of cases. The majority of patients was discharged from hospital before 8 days after surgery. Off pump coronary artery bypass surgery exhibit good results for most of the patients even if they present multiple vessel disease and high operating risk.
Annales françaises d'anesthèsie et de rèanimation, 1999
To assess the efficacy of hypertonic saline for prevention of arterial hypotension in patients un... more To assess the efficacy of hypertonic saline for prevention of arterial hypotension in patients undergoing spinal anaesthesia in Niger. Prospective, randomized, double-blinded study. Fifty adults undergoing scheduled surgery under spinal anaesthesia, allocated either to a hypertonic saline group (HSG) or a isotonic saline group (ISG). Over the 15 min prior to anaesthesia, 100 mL of 7.5% saline were infused in patients of HSG, and 100 mL of 0.9% saline in those of ISG respectively. Spinal anaesthesia was performed at the L3-L4 or L4-L5 interspace using either lidocaine 5%, or bupivacaine 0.5% or a mixture of both supplemented with fentanyl. Arterial pressure (AP) and heart rate (HR) were measured the day before surgery, prior to and after spinal anaesthesia, thereafter every 5 min over 30 min and every 10 min thereafter until completion of surgery. Hypotension (30% decrease of systolic AP control value was treated with 500 mL of Ringer lactate solution and in case of failure with ephe...
Médecine tropicale : revue du Corps de santé colonial, 1997
Destruction of the urethra is the most severe complication of pregnancy-related vesicovaginal fis... more Destruction of the urethra is the most severe complication of pregnancy-related vesicovaginal fistula. Although uncommon in Europe, pregnancy-related urethral destruction is still observed in Africa. In this study we describe our experience with a new reconstruction technique using a pedunculated skin flap raised from the labia majora. Between January 1992 and June 1996 we treated 35 patients in the Urology Department of Niamey Hospital in Niger. All patients were black. Mean age was 18 years and mean follow-up was 19 months. Two plasty techniques were used, i.e. extension (16 cases) and tubulisation (19 cases). Urinary incontinence was treated using a suburethral loop system created using a fatty flap taken from the labia majora (Martius method). Urethrocervico-suspension of the vagina was necessary in 6 cases. Normal micturition with no leakage was obtained in 24 patients (68.6%) and functional improvement in 6 cases (17.1%) Treatment failed in 5 cases (4.2%). In comparison with p...
The Journal of thoracic and cardiovascular surgery, 1994
Archives des maladies du coeur et des vaisseaux, 1994
Spasm of healthy native coronary arteries is rare but a serious cause of perioperative ischaemia ... more Spasm of healthy native coronary arteries is rare but a serious cause of perioperative ischaemia after coronary bypass surgery. The authors report five characteristic cases. In each case, the spasm presented with giant ST elevation and haemodynamic changes. In one case, further coronary bypass surgery was required. In three cases, symptomatic treatment of the hypotension associated with diltiazem completely cured the problem. One case was complicated by a small myocardial infarction. There were no fatalities. Previously reported cases often describe very heavy therapeutic protocols, justified by the high risks of this condition. Due to the fact that it is not possible to identify a target-population, simple prophylactic treatment with diltiazem seems to be justified in patients undergoing coronary artery bypass surgery.
Bulletin de la Société de pathologie exotique, 2014
The authors describe three cases of severe accidental poisoning by plants used as part of a tradi... more The authors describe three cases of severe accidental poisoning by plants used as part of a traditional treatment in Mayotte. The established, or suspected, toxicity of Thevetia peruviana (Yellow oleander), Cinchona pubescens (Red quinine-tree), Melia azaderach (Persian lilac, also called china berry) and Azadirachta indica (Neem), is discussed. The clinical presentation is cardiac (atrioventricular block) and well known for Thevetia and Cinchona intoxications. Neurological signs and multi-organ failure are found for Azadirachta and Melia. The identification of the plants is never easy, nor is the evidence of their accountability. In the three cases reported, no other cause than the traditional treatment has been found to explain the clinical presentation. The outcome was favorable in all cases. The authors emphasize the difficulties to investigate these accidents, the poor medical knowledge of these practices in tropical areas, and in Mayotte particularly. The need for cooperation with local botanists, familiar with traditional medicine, is also underlined.
Annales françaises de médecine d'urgence, 2015
training and an ill adapted prescription of Metformin seem to be main factors. The lactate rate a... more training and an ill adapted prescription of Metformin seem to be main factors. The lactate rate and the pH should not be considered as the ruling prognostic factors. The mortality is linked to seriousness of the associated pathologies.
Réanimation Urgences, 1997
Hypothermie accidentelle grave Pronostic et traitement & propos de deux observations Intreductien... more Hypothermie accidentelle grave Pronostic et traitement & propos de deux observations Intreductien L'hypothermie accidentelle est une affection frdquente. Seules les formes moyennes (temp6rature centrale < 32 °C) ou graves (temp6rature centrale < 28 °C), plus rares, posent des problbmes th6rapeutiques. La morta-lit6 en est 61evde, proportionnelle ~ la profondeur de l'hypothermie. Malgr6 cette gravit6, la litt6rature fran~aise sur le sujet reste assez peu abondante dans la dernibre d6cennie. Des publications r6centes [1-3] semblent toutefois t6moigner d'un regain d'int6r~t, ou d'une fr6quence plus 61ev6e lide la ddgradation de la situation sociale. Le choix d'une thdrapeutique plus ou moins invasive est souvent difficile et conditionn6 par les possibilit6s techniques locales. Deux observations illustrent ce dilemme th6rapeutique.
Bulletin de la Société de pathologie exotique, 2013
In Africa the destruction of the urethra is the most severe complication of pregnancy-related ves... more In Africa the destruction of the urethra is the most severe complication of pregnancy-related vesico-vaginal fistula. The authors report their experiences treating such conditions using an original procedure to reconstruct the urethra with the aid of a pedunculated skin flap raised from the labia majora. 35 cases of destroyed urethras treated using this approach between January 1992 and June 1996 in the Urology Department of the National Hospital of Niamey in Niger are reviewed. All patients were Black of mean age 18 years with a mean follow-up period of 19 months. The women ranged in age from 13 to 31 years old. An extension plasty technique was used in 16 cases and tubulization in 19 cases. The repair of urinary incontinence was achieved using a suburethral loop system created using a fatty flap taken from the labia majora. Urethro-cervico-suspension of the vagina was needed in 6 cases. Normal micturition with no leakage was achieved in 24 cases (68.6%) and there was functional im...
Bulletin de la Société de pathologie exotique, 2014
En 2012, 22,6 millions d'enfants dans le monde ne bénéficiaient toujours pas des vaccins de base.... more En 2012, 22,6 millions d'enfants dans le monde ne bénéficiaient toujours pas des vaccins de base. Le Plan d'Action mondial pour les Vaccins (Global Vaccine Action Plan-GVAP) 2011-2020 a une mission simple : améliorer la santé en étendant tous les avantages de la vaccination à tous les individus, quel que soit l'endroit où ils sont nés, qui ils sont et où ils vivent, d'ici 2020. Pour mettre en oeuvre le GVAP, il faut : • des financements : l'Alliance GAVI lancée en 2000 apporte un appui financier pour les vaccins dans les pays à revenu faible ou intermédiaire (PRF-PRI) ; • la sécurité des vaccins : rôle du Comité consultatif mondial de la sécurité vaccinale (Global Advisory Committee on Vaccine Safety-GACVS), crée en 1999 ; • une expertise : le Groupe stratégique consultatif d'experts (SAGE) sur les vaccinations créé en 1999 formule des recommandations sur les travaux du Département vaccination, vaccins et produits biologiques de l'OMS. Dans le cadre des Avancées vaccinales en 2012-2013 dans les PFR-PRI, nous étudierons les maladies évitables par la vaccination qui sont en voie d'élimination, les nouveaux vaccins, les vaccins en attente et les vaccins faisant l'objet de doutes sur leur sécurité. Entre 2000 et 2012, le nombre de cas de rougeole notifiés dans le monde a baissé de 73 %. En 2012, toutes les Régions
Médecine …, 2005
... P. DURASNEL, P. GALLET DE SANTERRE, D. MERZOUKI, M. RIDHOINE, M. CHARIF, A. DADA, FM LAHAYE .... more ... P. DURASNEL, P. GALLET DE SANTERRE, D. MERZOUKI, M. RIDHOINE, M. CHARIF, A. DADA, FM LAHAYE ... Le jeune âge des pat ients , le cara ct è re aigu et la réve rsibilité des affe ctions rencontrées expliquent ces « bons » résultats. ...
Medecine tropicale : revue du Corps de sante colonial, 2005
The purpose of this monocentric prospective cohort study was to assess mortality in intensive car... more The purpose of this monocentric prospective cohort study was to assess mortality in intensive care unit (ICU) patients requiring more than 6 hours of mechanical ventilation (MV) in a developing country. The study setting was a 10-bed polyvalent ICU at the Centre Hospitalier Régiona1 in El Maarouf, Comoros Islands. The study population included a total of 106 patients requiring MV out of 633 consecutive patients admitted to the ICU over a 10-month period. Study parameters included demographic data, simplified acute physiology score version 2 (SAPS II), reason for admission, urgency of MV, duration of MV, complications of MV need for sedation and mortality in hospital and at one year. In-hospital mortality was 59%. Mortality was significantly higher in patients presenting elevated SAPS II and requiring myorelaxant drugs. Age, gender, reason of admission, emergency, sedation, complications of MV, duration of MV were not correlated with mortality. The best prognosis was associated with ...
La destruction de l'uretre feminin, peu courante en Europe, est, en Afrique noire, la complic... more La destruction de l'uretre feminin, peu courante en Europe, est, en Afrique noire, la complication la plus severe des fistules vesico-vaginales d'origine obstetricale. Nous rapportons notre experience du traitement de ces destructions de l'uretre selon un procede original de reconstruction uretrale a l'aide d'un lambeau cutane pedicule preleve au niveau de la grande levre. Trente-cinq cas de destructions uretrales traitees par uretroplastie labiale pediculee entre janvier 1992 et juin 1996 dans le Service d'Urologie de l'Hopital National de Niamey, au Niger, ont ete analyses. Ces lesions concernaient des femmes de race noire dont l'âge moyen etait de 18 ans avec une mediane de recul de 19 mois. Deux variantes techniques ont ete realisees et sont decrites dans ce travail, la plastie d'allongement (16 cas) et la plastie tubulee de remplacement (19 cas). Le traitement de l'incontinence urinaire a ete assure par un systeme de fronde sous-uretrale ...
Médecine et Maladies Infectieuses
Bulletin de la société de pathologie exotique
Médecine et Maladies Infectieuses
Médecine et santé tropicales
Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have... more Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have largely completed their demographic and epidemiologic transitions. Major investments in infrastructure and social services have fostered steady economic growth. Health care and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population nonetheless present significant challenges for public health and the health system. Like the other small island states in the region, the Seychelles continue to be threatened by arbovirus outbreaks. Health indicators are good, but the geographic isolation, the small and aging population, and limited resources make a major challenge maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform, and increasing amount of medications particularly in view of the increasing burden of chronic diseases.
Annales de cardiologie et d'angéiologie, 2005
A consecutive cohort including 1080 patients undergoing "off-pump" myocardial revascula... more A consecutive cohort including 1080 patients undergoing "off-pump" myocardial revascularization was reviewed. An average of 2.22 bypass/patients was performed. The death-rate during the first 30 days after surgery was 0.65%. Four cases needed cross-over to on-pump. The postoperative events were: need of inotropic drugs (2.7%), atrial fibrillation (12.4%), myocardial infarction (6.6%). The extubation was performed before the first postoperative 24 h in 91.9% of cases. The majority of patients was discharged from hospital before 8 days after surgery. Off pump coronary artery bypass surgery exhibit good results for most of the patients even if they present multiple vessel disease and high operating risk.
Annales françaises d'anesthèsie et de rèanimation, 1999
To assess the efficacy of hypertonic saline for prevention of arterial hypotension in patients un... more To assess the efficacy of hypertonic saline for prevention of arterial hypotension in patients undergoing spinal anaesthesia in Niger. Prospective, randomized, double-blinded study. Fifty adults undergoing scheduled surgery under spinal anaesthesia, allocated either to a hypertonic saline group (HSG) or a isotonic saline group (ISG). Over the 15 min prior to anaesthesia, 100 mL of 7.5% saline were infused in patients of HSG, and 100 mL of 0.9% saline in those of ISG respectively. Spinal anaesthesia was performed at the L3-L4 or L4-L5 interspace using either lidocaine 5%, or bupivacaine 0.5% or a mixture of both supplemented with fentanyl. Arterial pressure (AP) and heart rate (HR) were measured the day before surgery, prior to and after spinal anaesthesia, thereafter every 5 min over 30 min and every 10 min thereafter until completion of surgery. Hypotension (30% decrease of systolic AP control value was treated with 500 mL of Ringer lactate solution and in case of failure with ephe...
Médecine tropicale : revue du Corps de santé colonial, 1997
Destruction of the urethra is the most severe complication of pregnancy-related vesicovaginal fis... more Destruction of the urethra is the most severe complication of pregnancy-related vesicovaginal fistula. Although uncommon in Europe, pregnancy-related urethral destruction is still observed in Africa. In this study we describe our experience with a new reconstruction technique using a pedunculated skin flap raised from the labia majora. Between January 1992 and June 1996 we treated 35 patients in the Urology Department of Niamey Hospital in Niger. All patients were black. Mean age was 18 years and mean follow-up was 19 months. Two plasty techniques were used, i.e. extension (16 cases) and tubulisation (19 cases). Urinary incontinence was treated using a suburethral loop system created using a fatty flap taken from the labia majora (Martius method). Urethrocervico-suspension of the vagina was necessary in 6 cases. Normal micturition with no leakage was obtained in 24 patients (68.6%) and functional improvement in 6 cases (17.1%) Treatment failed in 5 cases (4.2%). In comparison with p...
The Journal of thoracic and cardiovascular surgery, 1994
Archives des maladies du coeur et des vaisseaux, 1994
Spasm of healthy native coronary arteries is rare but a serious cause of perioperative ischaemia ... more Spasm of healthy native coronary arteries is rare but a serious cause of perioperative ischaemia after coronary bypass surgery. The authors report five characteristic cases. In each case, the spasm presented with giant ST elevation and haemodynamic changes. In one case, further coronary bypass surgery was required. In three cases, symptomatic treatment of the hypotension associated with diltiazem completely cured the problem. One case was complicated by a small myocardial infarction. There were no fatalities. Previously reported cases often describe very heavy therapeutic protocols, justified by the high risks of this condition. Due to the fact that it is not possible to identify a target-population, simple prophylactic treatment with diltiazem seems to be justified in patients undergoing coronary artery bypass surgery.
Bulletin de la Société de pathologie exotique, 2014
The authors describe three cases of severe accidental poisoning by plants used as part of a tradi... more The authors describe three cases of severe accidental poisoning by plants used as part of a traditional treatment in Mayotte. The established, or suspected, toxicity of Thevetia peruviana (Yellow oleander), Cinchona pubescens (Red quinine-tree), Melia azaderach (Persian lilac, also called china berry) and Azadirachta indica (Neem), is discussed. The clinical presentation is cardiac (atrioventricular block) and well known for Thevetia and Cinchona intoxications. Neurological signs and multi-organ failure are found for Azadirachta and Melia. The identification of the plants is never easy, nor is the evidence of their accountability. In the three cases reported, no other cause than the traditional treatment has been found to explain the clinical presentation. The outcome was favorable in all cases. The authors emphasize the difficulties to investigate these accidents, the poor medical knowledge of these practices in tropical areas, and in Mayotte particularly. The need for cooperation with local botanists, familiar with traditional medicine, is also underlined.
Annales françaises de médecine d'urgence, 2015
training and an ill adapted prescription of Metformin seem to be main factors. The lactate rate a... more training and an ill adapted prescription of Metformin seem to be main factors. The lactate rate and the pH should not be considered as the ruling prognostic factors. The mortality is linked to seriousness of the associated pathologies.
Réanimation Urgences, 1997
Hypothermie accidentelle grave Pronostic et traitement & propos de deux observations Intreductien... more Hypothermie accidentelle grave Pronostic et traitement & propos de deux observations Intreductien L'hypothermie accidentelle est une affection frdquente. Seules les formes moyennes (temp6rature centrale < 32 °C) ou graves (temp6rature centrale < 28 °C), plus rares, posent des problbmes th6rapeutiques. La morta-lit6 en est 61evde, proportionnelle ~ la profondeur de l'hypothermie. Malgr6 cette gravit6, la litt6rature fran~aise sur le sujet reste assez peu abondante dans la dernibre d6cennie. Des publications r6centes [1-3] semblent toutefois t6moigner d'un regain d'int6r~t, ou d'une fr6quence plus 61ev6e lide la ddgradation de la situation sociale. Le choix d'une thdrapeutique plus ou moins invasive est souvent difficile et conditionn6 par les possibilit6s techniques locales. Deux observations illustrent ce dilemme th6rapeutique.