Supports de conférences PPT et PDF

, , , ,

ANALISIS EPIDEMIA COVID-19 EN ESPAÑA Y EN EL MUNDO

Analisis Epidemia COVID 19 España  slides diaporama

 

Gérard Delépine es oncólogo, cirujano ortopédico y estadístico en el Hospital Raymond Poincaré de París (hoy jubilado). Ha desarrollado métodos quirúrgicos innovadores para tratar los tumores óseos y de los tejidos blandos. Su equipo en la Unidad Pediátrica Oncológica (POU) ha alcanzado una reputación internacional por combinar quimioterapia avanzada individualizada y cirugía conservadora. Junto con su esposa, la Doctora Nicole Delépine, pediatra y oncóloga, es autor e 3 libros y de más de 100 artículos de prensa.

 

 

 

 

Tasa de letalidad COVID-19 en las cárceles francesas:

-Las cárceles son un lugar de promiscuidad y no de confinamiento (en el patio los detenidos se abrazan, escupen al hablar cuando se enfadan, no respetan las distancias de seguridad).

-Por lo tanto en las cárceles, la epidemia de COVID-19 debería propagarse rápidamente

-El 03/04/2020 según estudio publicado sobre las 60.000 presos en las cárceles francesas:

48 presos testados positivos, 687 sintomáticos, o sea un total de 735 infectados y 3 muertos

lo que representa un tasa de letalidad de 3/735 = 0,4%

Tasa de letalidad COVID-19 España según datos oficiales OMS al 23/05/2020:

Infectados : 234.823   Fallecidos : 28.628

lo que representa una letalidad de 28628/234823 = 12,2% que NO es real

  (se han testado sólo los sintomáticos que acudían a urgencias y se ha aumentado ficticiamente el   número de muertos por COVID-19)

Tasa letalidad Gripe estacional en España 2018/2019:

-En la temporada de Gripe estacional Otoño-Invierno 2018-2019 según datos CSIC en España :

525.000 infectados, 6.300 fallecidos

lo que representa una letalidad de 6300/525000 = 1,2%

 

 

 

Ultimas análisis realizadas en Francia por médicos según datos de campo en Francia 10/05/2020 :

-Para los menos de 30 años sin patologías asociadas, el riesgo de morir de COVID-19 es prácticamente nulo

-Para los menos de 50 años sin patologías asociadas (obesidad, diabetes, hipertensión, cáncer, etc.), el riesgo es bajo

-El riesgo de fallecimiento es alto para los más de 70 años (85% de los fallecimientos en Francia)

Tasa contagio en el cárcel “La Santé” en Francia al 29/04/2020 :

Presos : 870   Infectados : 6     Fallecidos : 0

lo que representa una tasa de contagio de 6/870 = 0,7%

  lo que sugiere una tasa de contagio baja

Tasa contagio en España al 23/03/2020 :

Infectados : 234.823 (OMS)     Población : 46.940.000

lo que representa una tasa de contagio de 234823/46940000 = 0,5%

  Si suponemos que en realidad el número de infectados es el doble :

tasa de contagio de 469646/46940000 = 1% que sigue siendo bajo y similar a la gripe estacional

Tasa contagio en España gripe estacional Otoño-Invierno 2018-2019 :

Infectados : 525.300 (CSIC)     Población : 46.940.000

lo que representa una tasa de contagio de 525300/46940000 = 1,1%

, ,
COVID19 Genèse et conséquences d’une hystérie mondiale

COVID19 Peste ou epidémie 2020 AMETIST

 

diaporama présenté en conférence chez la présidente d’Ametist le 20 MAI 2020  pour faire le lien sur l’épidémie et la manipulation que nous venons de traverser.
cliquez sur le lien ci-dessus pour voir le diaporama et pour toute question supplémentaire n’hésitez pas à joindre le dr G Delépine

gerard.delepine@bbox.fr

 

vous pouvez joindre la présidente d’Ametist, Mme Patras Turco Line

lt4@live.fr

, , , ,

Long term results of high dose vancomycin loaded spacers for treating infected massive prostheses

 

Long term results of high dose vancomycin loaded spacers for treating infected massive prostheses

Poster spacer ciment athenes 2019-2               Delepine F, Alkhallaf S. Delepine G.

 

Aim

infection is of the most devastating complication of conservative surgery using massive prosthesis, leading frequently to amputation. The aim of this bi centric study is to precise the influence of spacer loaded with high doses of vancomycin on late results

 

Patients From 1984 to 2010, we operated more than 670 patients with bone sarcoma. Aged 4,5 to 82 years (mean 25 y). Histology was osteosarcoma (330), Ewing (175), chondrosarcomas (148), fibrosarcomas or MFH (23), giant cell tumours in others. In 502 cases, p received chemotherapy, and radiotherapy in 50 cases. The median follow-up from tumour removal is 20.5 years. 62 p suffered of deep infection of the material used to reconstruct the skeletal defect. 3 p were refered to us for recurrence of deep infection initially treated elsewhere. Altogether, we treated 65 patients for deep infections.

Method 28 p had debridment and cleaning of the prosthesis and long adapted antibiotherapy as first treatment. When ineffective (25/28), a removal of the prosthesis was performed with immediate re insertion of prosthesis in 19 cases. When infection recurred (16/19) and in 34 other patients the treatment included a two stages protocol with interposition of a spacer with antibiotic loaded cement during 4 to12 weeks .Until 2004, the spacer was made with gentamycin containing palacos mixed with conventional doses of antibiotics adapted to the germ. From 2004/6 we used high doses of vancomycin (4 g per batch of 40 g) with an average total dose of 11g of vancomycin per spacer. The new prosthesis was replaced secondarly when infection, cutaneous and muscular problems were solved.

RESULTS : At last control, 16 were amputated, following a mean of 6 ineffective procedures. 46 p. benefited from conservation surgery but a new prosthesis could be inserted only in 43, following a mean of 3.2 surgical procedures. Analysis shows the very bad prognostic value of initial radiotherapy, of distal locations, the importance of muscular coverage and the efficacy of high dose vancomycin in spacer. Up to date, none of the high dose vancomycin loaded spacers was followed by amputation

CONCLUSION Infection of massive prostheses is the most serious orthopaedic complication of limb salvage. Treatment must be preventive, avoiding any radiotherapy. Good prognostic factors of deep infection are early removal of the prosthesis, improvement of the muscular coverage, and use of spacers with high dose vancomycin.

 

, , , ,

Long term follow-up of 7 periosteal Ewing. Key points for surgery

slides 

Poster Ew périosté athenes 2019-2 (1)   

 

 

 

Long term follow-up of 7 periosteal Ewing. Key points for surgery 

F Delépine, G Delépine, S Alkhallaf

Aim of the study. Few cases of periosteal Ewing (PES) were reported and surgical implications of such a diagnosis has not been sufficiently underlined. Our goal is to evaluate the incidence of this topographic form and the consequence on surgery and long-term results.

Material. The 7 reported cases fulfilled the diagnosis criteria of Bator: Ewing of bone histologically proved, with pure periosteal location without medullary extension. The CT scan was the most reliable exam for diagnosis. Histology of resected specimen may ignore an initial medullary involvement cured by preoperative chemotherapy. M.R.I. can overestimate a PES with intense inflammatory reactive tissue inside the medullary canal.

Results

Out of 175 Ewing of bone of our file, only 7 (4 %) could be classified as PES. 6 involved the femoral bone (4 diaphyseal orand 2 metaphyso diaphyseal) and one the tibia (distal metaphysis). Age of patients at biopsy ranged 11 to 19. Two patients have been referred to us after biopsy. One was irradiated before we saw her. According to Ennecking classification, 3 were graded IIA and 4 II B. All patients were treated by resection after preoperative chemotherapy. With an median follow up of 198 months, all 7 patients are event free survivors.

In three cases a transcortical biopsy was performed compelling to perform a resection interrupting the long bone continuity; Two patients were reconstructed with long stem prosthesis and were re operated 2 and 4 times during the 18 and 19 years of follow up. For the distal tibia the limb salvage using allograft and vascularized fibula was followed by pseudarthrosis then infection with a total of 6 operations (in 3 years) before cure. In four cases the biopsy did not open the medullary bone; Nevertheless in three case sthe local extension compells to interrupt the long bone continuity before allograft reconstructions with 2 excellent and 1 good long-term results. The last case could benefit of partial resection of bone with cement filling and excellent immediate result.

Comments.With these cases (6 had been already reported), only 35 cases of PES have been described, 32 / 35 located on long bones. Most were stage II disease, treated by chemotherapy and surgery. At last follow up 33 / 35 patients (94 %) were in first remission confirming the good prognostic value of PES.

Conclusions.The surgical consequences of PES must be underlined. When computed imaging permits to suspect this diagnosis biopsy should be confined to the soft tissues and/or the cortical bone without medullary contamination. Such a procedure eventually permits subsequent partial resection without interruption of the bone continuity, allowing easier reconstruction and much better long term functional results.

 

, , , ,

Very long-term follow-up of composite prostheses after periacetabular resection

slides

ISOLS2019 long term follow up of acetabular prostesis for malignancies

 

Very long-term follow-up of composite prostheses after periacetabular resection.

Fabrice Delépine, Gérard Delépine

 

Materials and methods.

The “hand on innominate prosthesis” described by us in 2003 (Sarcoma 2003) is made of a titanium cup, a set of long titanium screws and 2 or 3 packs of antibiotics loaded cement. To evaluate the orthopedic results of the implants, we take in account the score at last local control. We use the numerical rating assessing each of the seven variables of the MSTS system on a five-point scale, giving a maximum score of 35 points, recorded as 100 %. Between 1990-2007, 84 patients (p) with peri acetabular bone sarcoma (40), metastases (44) were treated by internal hemipelvectomy followed by this reconstructive procedure. 23 survivors (20/40 sarcomas, 3/44 metastases) have been followed more than 5 years. Histology of 23: chondrosarcoma: 8, osteosarcoma:5, Ewing: 5, MFH: 1, anaplasic sarcoma :1, renal cell carcinoma 2, thyroid 1. Resection included 4 zone 2, 6 zone 2+3, 9 zones 2+1, 3 zones 2+1+4, and 1, zones 1+2+3.

Results.

Median FU of these 23 p is 18,5 years (133- 301 months). Postoperative complications included 1 deep infection, 6 hip prosthesis dislocations (26%), 2 neurologic palsies. Late complications were 2 deep infections, 8 polyethylene wears and 8 loosening (5 iliac, 3 femoral). 17 p (73 %) had to be re operated. The type of orthopedic complications is significantly correlated with the topography of the resection: loosening of the iliac prosthesis threatens only resection of zone 1.

The mean functional result, rated according modified Ennecking’s grading system, was 80%. Result similar to those described in the literature for custom made innominate prosthesis and better than those of published alternative reconstructive procedures.

 

Conclusions.

The immediate weight bearing and the durability of such a procedure plea for using it after acetabulum resection of zone 2 and 3 (we did not observe loosening of the iliac reconstruction). Such a procedure can also be used after total iliac wing resection, even when including zone 4. But in this location loosening is frequent and pleas for reinforcing the reconstruction with the head and neck of femur when there are free of tumor as advocated by Puget (RCO 2012)

 

, , , ,

Paradoxical oncologic results of HPV vaccination in real life A cancer registers study

  SLIDES   29 2 2020 Gardasil ENGLISH 

 

Paradoxical oncologic results of HPV vaccination in real life

A cancer registers study
Dr G Delépine surgeon oncologist statistician N Delépine pediatrician oncologist
Paris, France nicole.delepine@bbox.fr gerard.delepine@bbox.fr
Authors have no competing interest

, , , ,

DEGRADATION MAJEURE DE NOTRE SYSTEME DE SANTE PUBLIC ET PRIVE : COMMENT ? POURQUOI ? QUE FAIRE ?

système de santé Nice AMETIST 16 NOV 2019

cliquez sur le lien pour dérouler le diaporama de la conférence donnée à Biot le 16 NOV 2019

 

 

GUERIR NOTRE SYSTEME DE SANTE EN QUELQUES GRANDES REFORMES PAR RETOUR A LA LIBERTE DE SOIGNER ET D ETRE SOIGNE

 

Il faut une volonté politique plus que de l’argent magique : déplacer les sommes colossales détournées par la technocratie, les rendre aux hôpitaux publics et à la médecine libérale, pour redonner des couleurs à nos soignants et à nos structures de soins et donc à nos patients

Comment : en rendant la liberté thérapeutique, tarifaire, organisationnelle aux médecins libéraux et autres professionnels de santé, aux établissements publics et privés, en les libérant du joug bureaucratique créé par les ministères successifs depuis des décennies, en supprimant les agences régionales de santé

Du temps où notre système de santé était au premier rang mondial, les médecins de ville, les cliniques privées, les hôpitaux publics, ainsi que les autres professionnels de santé (dentistes, opticiens, kinésithérapeutes, psychologues etc) avaient de grandes libertés de manœuvre, tant thérapeutiques, tarifaires, qu’organisationnelles. Les individus devaient démontrer leurs compétences par leurs diplômes nationaux, et une fois ceux-ci obtenus, exercer leur art en toute indépendance, comme il sied pour une profession libérale dans une démocratie. Les patients étaient là pour protester en cas de problèmes (justice), et il n’y avait pas besoin de gendarme derrière chaque médecin, chaque kinésithérapeute, chaque dentiste pour qu’ils fassent efficacement et honnêtement son métier.

Les jeunes médecins, qui n’ont pas exercé avant les années 2000, n’imaginent pas la vie sans ARS. Classé premier système de santé au monde en 1998, le système mis au point par le Conseil National de la Résistance (ordonnances 4 et 19 octobre 1945), la sécurité sociale, était robuste et a mis plusieurs décennies à craquer. Nous y sommes.

Nous parlerons ensemble des outils du pouvoir pour contraindre les soignants et malades : les agences régionales de santé, mortifères qu’il faut supprimer, et la main-mise de l’état sur la sécurité sociale en vente au privé.

 

voir aussi sur agoravox nos tribunes sur la bureaucratie mortifère  qui a tué notre système de santé ou sur ce site

 

 

 

, , ,

CRISE DE LA SANTE : SOIGNER OU OBEIR ?

 CLIQUEZ SUR LE LIEN CI DESSUS pour écouter la conférence
QUELLE REPONSE AUX URGENCES ET AU DESESPOIR DE L HOPITAL ? AUCUN TANT QUE LA MAIN MISE DE LA BUREAUCRATIE ETRANGLERA LES MEDECINS ET SOIGNANTS
la santé au service du capital, la sécu disparue ou quasiment, les malades abandonnés ! faites un tour dans l’ehpad du coin …
aucune réforme de l’hôpital public  (oubliant la ville de plus ) ne pourra  améliorer le système de santé  si on ne s’attaque pas à la liberté de soigner, à supprimer la main mise de l’administration sur les décisions médicales
 GRAVISSIME   !   SUPPRIMER LES ARS ET LEUR POUVOIR DE NUISANCE
 SANS S’ ATTAQUER A LA MAIN MISE DE L’ ADMINISTRATION SUR NOS DECISIONS MEDICALES  AUCUN ESPOIR D AMELIORATION !
 c’ est le problème de nous tous !
, , ,

    2019 Senlis gardasil def du 9 11    

    2019 Senlis gardasil def du 9 11    

CLIQUEZ SUR LE LIEN CI DESSUS POUR DEROULER LE DIAPORAMA

mise à jour à l’occasion d’un agréable débat à  Senlis de la bibliographie actualisée des effets du Gardasil sur les taux de cancer  du col  de l’utérus. Malheureusement l’effet paradoxal se confirme !