The course of 260 adults with haematological malignancies admitted to a medical intensive care unit was studied to evaluate the value of life support techniques and to research predictive factors. The overall in the medical intensive care unit (MICU) and hospital mortality rates were respectively 43% (113 patients) and 57% (148 patients). Among survivors, 64% (49 patients) were still alive after 6 months and 44% (35 patients) after 1 year. Among 34 haemodialysed patients, the MICU mortality was 67% (23 patients) and among 111 mechanically ventilated patients 85% (94 patients). Prolonged mechanical ventilation, more than seven days, was performed in 11 of the 17 survivors and did not influence long term survival. No individual predictor of mortality was found comparing survivors and non-survivors. However, SAPS, intractable sepsis and failure of more than one organ system were significantly different in non-survivors (p less than 0.001). Among the 20 patients requiring both mechanical ventilation and haemodialysis, only two left the MICU and both died soon thereafter. We conclude that life support therapy should be initiated in patients with haematological disorders and that prolonged mechanical ventilation is compatible with long term survival. However, the combination of mechanical ventilation and haemodialysis is always associated with a poor prognosis and therefore the use of both techniques simultaneously for one patient is questionable.
A report is given on two neutropenic patients with staphylococcal septicemia caused by Staphylococcus haemolyticus and Staphylococcus aureus (both strains methicillin-resistant) who failed to respond to therapy with teicoplanin. Both strains were resistant to teicoplanin (MIC 16 and 8 mg/l respectively), but remained sensitive to vancomycin (MIC 2 and 4 mg/l respectively). Replacement of teicoplanin with vancomycin led to full recovery of both patients and their discharge from hospital. These two cases emphasize the importance of clinical and microbiological monitoring of patients with staphylococcal septicemia, even when glycopeptides are used for treatment.
Résumé Dans la mesure où le rôle de l’État est mis en question depuis deux décennies et où la signification des valeurs qui le légitiment est de plus en plus incertaine, peut-on encore avoir l’ambition de servir l’État ? Les changements auxquels ce dernier est confronté impliquent que soient repensés le périmètre et les modalités de son action : ce vaste chantier de la « modernisation » devrait attirer, aujourd’hui comme dans le passé, les jeunes diplômés qui ambitionnent d’être des acteurs de la réforme.
A la recherche du temps perdu. La science politique française oublieuse de l'administration publique. A propos de Notre Etat
Françoise Dreyfus
Ce papier propose une lecture critique de Notre Etat. Le livre vérité de la fonction publique, livre publié en 2000 sous la direction de Roger Fauroux et Bernard Spitz et qui réunit les contributions de 28 hauts fonctionnaires. Cet ouvrage se présente comme un appel à la réforme de l'Etat mais ne réussit pas à quitter le registre politique et à s'appuyer sur des analyses très approfondies de la réalité bureaucratique. En ce sens, la nécessité de multiplier les travaux de science politique sur l'administration se fait de plus en plus urgente.
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