Hospital In Paris Research Articles

Social networks and confinement, a real impact on families

The various lockdowns linked to the Covid-19 epidemic have modified the use of communication tools, the Internet and social networks. In the context of the walk-in clinic or the child psychiatric evaluation interviews conducted at the Maison des adolescents of the Cochin Hospital in Paris, families were able to discuss the difficulties arising from this new use. Certain transgenerational, cultural and usual misunderstandings were discussed.

War and peace in hospitals: Humans, objects and paradoxes

Patient-centered care (PCC) in French hospitals has become highly topical. As it challenges people's roles and positions in the health care system, it generates tensions that can produce paradoxes when elements perceived as contradictory are both present and persistent. However, the actors most often learn to deal with them. The aim of this research is to examine how actors cope with the paradoxes created by PCC. Linking the theory of paradox to the concepts of situated action and object agency, this paper studies the orthopedics department of a major PCC public hospital in Paris based on shadowing, interviews and secondary documents. It highlights three ways in which technical objects play a key role in managing belonging, learning, organizing and performing paradoxes generated by PCC: enactment, mediation and interpretive flexibility. It thus extends the dynamic equilibrium model of organizing in the theory of paradox developed by Smith and Lewis (2011).

Oral health-related quality of life in patients with X-linked hypophosphatemia: a qualitative exploration.

IntroductionX-linked hypophosphatemia (XLH) is a rare, hereditary, and lifelong phosphate-wasting disorder characterized by rickets in childhood and impaired teeth mineralization. In the oral cavity, spontaneous abscesses can often occur without any clinical signs of alteration of the causal tooth. The objective of our study was to evaluate the oral care pathway and the oral health-related quality of life (OHRQoL) of patients following in an expert oral medicine department located within a Parisian hospital and working in close collaboration with an endocrinology department expert in this pathology.MethodsThis study employed a qualitative descriptive design including semi-structured interviews using guiding themes.ResultsTwenty-one patients were included in the study. The topics brought up exceeded the initial objectives as the patients mostly addressed the alteration of their oral health-related and general quality of life; a very chaotic oral health care pathway with oral health professionals not aware of their pathology; consequences on their social, professional, and school integration. Patients declared the importance of having a multidisciplinary team around them, including medical and dental professionals.ConclusionsThe variety of manifestations in patients with XLH necessitates high coordination of multidisciplinary patient care to optimize quality of life and reduce disease burden. Oral health care pathways are very chaotic for patients who have difficulty in finding professionals with sufficient knowledge of the disease. OHRQoL is therefore diminished. This situation improves when patients enter a coordinated care network.

Management of Undocumented Immigrants With End-Stage Kidney Disease in 2 Academic Hospitals in Paris

The burden of kidney disease has been growing steadily throughout the world. It is estimated that around 2 million patients, most of whom live in low and lower-middle income countries, reach end-stage kidney disease (ESKD) annually, and this is anticipated to worsen in the coming years.1–3 Kidney replacement therapy (KRT) requires highly technical equipment and expertise, which are costly. As a consequence, KRT is very unevenly distributed worldwide.4 The management of undocumented immigrants suffering from ESKD without medical insurance raises complex medical, social, financial, and ethical questions in countries with ample healthcare resources.

Systematic assessment of the humoral response against SARS-CoV-2 in a French cohort of 283 patients with rheumatic diseases.

ObjectivesTo estimate the seroprevalence of SARS-CoV-2 infection in patients with rheumatic diseases and to specify the proportion of asymptomatic and symptomatic forms of COVID-19.MethodsWe screened for SARS-CoV-2 infection among spondyloarthritis (SpA, n = 143) or rheumatoid arthritis (RA, n = 140) patients in our outpatient clinic at Cochin Hospital in Paris between June and August 2020. We performed a qualitative SARS-CoV-2 serological test which detects IgG directed against the N nucleocapsid protein (anti-N) and, for some patients, against the Spike protein (anti-S). Descriptive analyses were managed.ResultsDuring June–August 2020, the SARS-CoV-2 seroprevalence rate in our population was 2.83% (8/283 patients) without significant difference between RA and SpA patients (2.14% and 3.5%, respectively). We report 11 out of 283 patients (3.8%) with a diagnosis of SARS-CoV-2 infection. Among these 11 patients, 1 patient was asymptomatic (9%) with a confirmed diagnosis of COVID-19 by anti-S serology. Of the 283 patients, 85% were under bDMARDs, mainly on rituximab (RTX) (n = 44) and infliximab (IFX) (n = 136).ConclusionsThe seroprevalence of SARS-CoV-2 in patients with rheumatic diseases, mainly under bDMARDs treatments, was 2.83%. Among infected patients, 9% were asymptomatic. Detecting SARS-CoV-2 infections could be based on the strategy using patients’ interview and anti-N serology.

Rectal Bleeding and Cow’s Milk Protein-induced Allergic Proctocolitis: A Prospective Study

To assess time to resolution of food protein–induced allergic proctocolitis (FPIAP).In this study, researchers evaluated 76 infants aged <4 months with rectal bleeding (RB) referred to the pediatric gastrointestinal department at Trousseau Hospital in Paris, France, between May 2014 and December 2017. Only infants whose RB responded to a cow’s milk elimination diet were included in the study.This was a prospective cohort of infants with concern for cow’s milk protein (CMP) allergy who had resolution of RB with CMP elimination. Exclusion criteria included RB because of another etiology and exclusively breastfed infants. A total of 2 to 8 weeks after resolution of RB, CMP oral food challenge (OFC) was completed. If FPIAP was confirmed, OFC was repeated every 2 months after the age of 4 months to assess the time to tolerance of CMP. Ongoing FPIAP CMP was defined as RB, behavioral change, diarrhea, and vomiting. Tolerance was defined as CMP daily without symptoms.Only 31% of the cohort failed OFC at initial diagnostic challenge, meaning that over two-thirds of infants who initially responded to CMP exclusion did not have return of symptoms on rechallenge just weeks later. Of the patients confirmed to have FPIAP CMP, the median age of tolerance was determined to be 6.8 months, with >75% of the cohort tolerant by 10 months. Infants with a first-degree family history of atopic disease developed tolerance later (8.9 months versus 5.1 months).In this work, it was confirmed that the majority of RB in infants is likely not related to FPIAP CMP. This study also revealed that the time to resolution might be earlier than previously thought.Although there are no solid guidelines on introduction of CMP in presumed FPIAP CMP, the majority of patients exclude CMP until approximately 1 year. In this study, it was found that only one-third of RB before 4 months was due to FPIAP. Of those with FPIAP, CMP could be challenged earlier and at more frequent intervals depending on family wishes. A major limitation of this study is that exclusively breastfed infants were excluded and the lack of information on maternal diet in those who were nursing.

Distinctive neuropsychological profiles of lateral temporal lobe epilepsy

ObjectiveLateral temporal lobe epilepsies (LTLE) are poorly characterized heterogeneous epilepsies. As the lateral temporal lobe supports distinct functions, we hypothesized that neuropsychological profiles could differ according to the localization of the seizure focus within the lateral temporal lobe. MethodsWe retrospectively examined the neuropsychological characteristics of 74 consecutive patients with refractory LTLE assessed in the context of a presurgical investigation at the Pitié-Salpêtrière Hospital in Paris between 1998 and 2018. Precise localization of the epileptic focus was correlated with scores on tests of intelligence (Global, Verbal and Performance IQ), working memory, episodic memory (verbal and visual learning and forgetting), executive functions, and language abilities. ResultsWe demonstrated an impact of the localization of the epileptic focus within the lateral temporal lobe with worse learning and/or executive performances depicted in the infero-basal and pure pole LTLE groups and greater language difficulties in the posterior LTLE group, Antiepileptic drugs had a greater effect than parameters related to the epilepsy itself as the lesion or the disease duration, and finally as in medial TLE, the age, education, and sex influenced some cognitive performances. ConclusionOur findings show that the lateral temporal neocortex is also part of the neural substrate for memory processing and executive functions and suggest that this involvement could be related to functions devoted to specific subregions of the temporal lobe (i.e., temporal pole, inferior and basal regions) that support language and semantic processing.

Профессор Иоахим Альбарран. Уролог и ученый, опередивший свое время…

The article analyzes the scientific and practical activities of the prominent French urologist Professor Joachim Albarran (1860-1912). It is noted that a student of the founder of French urology F. Guyon I. Albarran in 1906 was elected in his place Professor of urology and head of the Department of the Necker hospital (Hopital Necker) in Paris. It is shown that in 1891 he published a work on bladder tumors, creating a new progressive classification of them. This paper presents well-known monographs by I. Albarran on the mechanism of origin of hydronephrosis, tuberculosis, and kidney tumors. He developed a method for studying the functional activity of the kidneys and proposed the method of experimental polyuria (1905). It is also noted that I. Albarran invented the catheterization cystoscope and this made ureteral catheterization a method widely available in practical surgery. I. Albarrans extensive operational experience was described in his manual of operative surgery of the urinary tract (1909), which still has not lost its value. I. Albarran created a brilliant scientific school, from which came a whole galaxy of outstanding clinicians and urologists.

Editorial introductions.

Editorial introductions.

Cardiometabolic Disorders and the Risk of Critical COVID-19 as Compared to Influenza Pneumonia.

We aimed to compare the influence of cardiometabolic disorders on the incidence of severe COVID-19 vs. non-COVID pneumonia. We included all consecutive patients admitted with SARS-CoV-2-positive pneumonia between 12 March 2020 and 1 April 2020 and compared them to patients with influenza pneumonia hospitalized between December 2017 and December 2019 at the same tertiary hospital in Paris. Patients with COVID-19 were significantly younger and more frequently male. In the analysis adjusted for age and sex, patients with COVID-19 were more likely to be obese (adjOR: 2.25; 95% CI 1.24–4.09; p = 0.0076) and receive diuretics (adjOR: 2.13; 95% CI 1.12–4.03; p = 0.021) but were less likely to be smokers (adjOR: 0.40; 95% CI 0.24–0.64; p = 0.0002), have COPD (adjOR: 0.25; 95% CI 0.11–0.56; p = 0.0008), or have a previous or active cancer diagnosis (adjOR: 0.54, 95% CI 0.32–0.91; p = 0.020). The rate of ICU admission was significantly higher in patients with COVID-19 (32.4% vs. 5.2% p < 0.0001). Obesity was significantly associated with the risk of direct ICU admission in patients with COVID-19 but not in patients with influenza pneumonia. Likewise, pre-existing hypertension was significantly associated with mortality in patients with COVID-19 but not in patients with influenza pneumonia. Cardiometabolic disorders differentially influenced the risk of presenting with severe COVID-19 or influenza pneumonia.

Benefits and risks of bronchoalveolar lavage in severe asthma in children.

BackgroundAlthough bronchoscopy can be part of the exploration of severe asthma in children, the benefit of bronchoalveolar lavage (BAL) is unknown. The present study aimed to decipher whether systematic BAL during a flexible bronchoscopy procedure could better specify the characteristics of severe asthma and improve asthma management.Material and methodsThe study took place in two departments of a university hospital in Paris. Children who underwent flexible bronchoscopy for the exploration of severe asthma between April 2017 and September 2019 were retrospectively included.ResultsIn total, 203 children were included, among whom 107 had a BAL. BAL cell count was normal in most cases, with an increasing number of eosinophils with age, independently from the atopic status of the patients. Compared with bronchial aspiration only, BAL increased the rate of identified bacterial infection by 1.5. Nonatopic patients had more bacterial infections (p<0.001). BAL induced a therapeutic modification only for azithromycin and omalizumab prescriptions. The practice of a BAL decreased bronchoscopy tolerance (p=0.037), especially in the presence of tracheobronchial malacia (p<0.01) and when performed in a symptomatic patient (p=0.019).Discussion and conclusionAlthough BAL may provide interesting information in characterising severe asthma, in most cases its impact on the patient's management remains limited. Moreover, BAL can be poorly tolerated and should be avoided in the case of tracheobronchial malacia or current asthma symptoms.

Diagnosis Yield and Safety of Surgical Biopsy in Interstitial Lung Diseases: A Prospective Study

BackgroundSurgical lung biopsy is essential in the diagnostic algorithm of interstitial lung disease (ILD) of unknown cause. Safety concerns have been recently reiterated. This study prospectively assessed the yield of diagnosis and safety of video-assisted thoracoscopic surgical lung biopsy (VATS-LB) for ILD diagnosis. MethodsThis prospective study, conducted in 6 ILD-referral Paris hospitals, included 103 patients with ILD. VATS-LB was proposed after initial multidisciplinary discussion. A final diagnosis was made after the procedure, during a second multidisciplinary discussion. The main outcome was to determine the final diagnoses and their proportion after VATS-LB. Other outcomes were the percentage of change in diagnosis and treatment propositions after VATS-LB and adverse events during 3 months after the operation, postoperative pulmonary function, quality of life, and pain. ResultsA definite diagnosis was reached in 87 patients (84.4%), and 16 remained unclassifiable (15.6%). After VATS-LB, the hypothesized diagnosis changed in 65 patients (63.1%) and treatment changed in 41 patients (39.8%). One patient died of acute exacerbation. In-hospital complications were predicted by a shorter preoperative 6-minute walking test distance and by forced vital capacity lower than 77%. Postoperative quality of life was not modified at 3 months, whereas forced vital capacity decreased slightly. Postoperative neuropathic pain was revealed in 5% of patients at 1 month and in 2% at 3 months. ConclusionsVATS-LB dramatically changed preoperative hypothetical diagnoses and treatment in ILD of unknown cause, with good patient survival in ILD referral centers.

Psilocybin in the treatment of anorexia nervosa: The English transition of a French 1959 case study

Psilocybin is a psychotropic molecule that is a partial agonist of serotonin 2A receptors and is the main psychoactive compound in hallucinogenic mushrooms. After the observation in 1953 in Mexico of ritual practices involving ingestion of such mushrooms, psilocybin was chemically characterized and synthesized in 1958 thanks to the collaboration between the Muséum national d’Histoire naturelle in France and the Sandoz pharmaceutical laboratories in Switzerland. The interest of this substance in psychiatric therapy was then evaluated for the first time at the Sainte-Anne Hospital in Paris, by the team of Professor Jean Delay. Among the patients who received this substance was a 35-year-old woman who was hospitalized for compulsive manifestations emblematic of anorexia nervosa and who experienced an immediate and lasting improvement. The original 1959 article (published in the Annales de la Société Médico-Psychologique) gives details of the patient's family background, biography and clinical examination. It then outlines the observations after two injections of psilocybin four days apart, in particular the autobiographical verbal statements that allowed the patient to understand the psychogenesis of her illness. After a long hiatus, psilocybin is once again the subject of medical research, with clinical trials now underway assessing psilocybin in the treatment of anorexia nervosa (NCT04505189; NCT04052568; NCT04661514) and this 1959 case study, is the first known demonstration of the safety and efficacy of psilocybin treatment of anorexia nervosa. This case study thus provides an interesting insight into possible therapeutic mechanisms and is of great interest to the field moving forward.

Prof. Dr. Michel Zerah

Michel Zerah was born on May 22, 1956 in Paris, France. He finished his medical study in 1985 at Faculté de médecine de CRETEIL (Paris, France) and graduated in Neurosurgery in April, 1988.&#x0D; Quickly took over as head of Clinic-Assistant of Paris Hospitals, “Service de Neurochirurgie de l’hôpital de Bicêtre” (1989) and as university professor (1998) at “Service de Neurochirurgie pédiatrique” of hospital group “Necker-Enfants Malades”.&#x0D; Prof. Zerah was a great teacher and mentor to countless neurosurgeons, around the world and here in Brazil.&#x0D; He participated in several courses and congresses, highlighting his unconditional dedication to teaching. With his knowledge, his humility and incredible charisma he made countless friends and students wherever he went. His lectures have always been unique experiences, approaching each subject in a masterly way, with emphasis on craniocervical transition diseases and spinal dysraphimos.&#x0D; He has authored more than 261 scientific articles and several books and book chapters, with emphasis on lumbar lipomas surgery, Chiari, deposit diseases, among others. His last project was the development of fetal surgery at Necker Hospital.&#x0D; Michel Zerah had an incredible ability to bring people together and, thus, he walked a path of respect, affection and friendship wherever he went.&#x0D; He was head of the Pediatric Neurosurgery Service at Hospital Necker, Paris, France where he devoted a large part of his life, teaching and operating numerous children.&#x0D; An immense and irreparable loss for everyone who knew him and who had the privilege of working and living with him.&#x0D; Short Biography:&#x0D; &#x0D; Head of the Pediatric Neurosurgery Service – Hospital Necker, Paris, France&#x0D; President of the European Society for Pediatric Neurosurgery (ESPN)&#x0D; President of the French Society of Pediatric Neurosurgery&#x0D; Member of the French National Academy of Surgery&#x0D; PhD in Mathematics, Statistics and Computer Science&#x0D; Coordinator of the European Course on Pediatric Neurosurgery between 2002 and 2014.&#x0D; Collaboration with the Society of Neurosurgery of Vietnam where he practiced solidarity work and trained numerous professionals.&#x0D; 324 communications or conferences in National or International Meetings&#x0D; 32 Chapters in Books&#x0D; 123 articles in Scientific Journal&#x0D;

PD-L1 (Programmed Death Ligand 1) as a Marker of Acute Cellular Rejection After Heart Transplantation.

PD-L1 (Programmed Death Ligand 1) as a Marker of Acute Cellular Rejection After Heart Transplantation.

Hospital compounding to face shortage: A case study of the development of a lopinavir-ritonavir oral suspension during the first wave of SARS-COV-2 in France

The potential usefulness of lopinavir-ritonavir on Covid 19 infection during the first wave of contamination in France had boosted Kaletra® syrup prescription to the point of causing its national shortage. In the intensive care units of Parisian hospitals in charge of patients with life-threatening viral contamination, caregivers had to resort to lopinavir-ritonavir-based tablets, crushing them and then dispersing the powder in milk to facilitate administration by nasogastric tube. The difficulties and poor control of this degraded mode, which does not always ensure control of the amount of the drug in the prepared dose and may induce insufficient antiviral exposure, led us to develop in a very short time, while ensuring quality control proportional to the risk, a liquid form as an alternative to Kaletra® oral solution shortage. For this purpose, we describe this compounding formulation and its preparation process, while justifying the quality control strategy adapted to the risk as well as its chemical and physical stability. Based on the chemical and physical studies, the preparation was showed to be stable during at least 2 months between +2 °C and +8 °C and 1 week at room temperature. This has resulted in the design of kits that include multi-dose packaging and a measuring device and contain the appropriate quantities of drugs to ensure at least one week's treatment for each patient, during which time the kit in use can be stored at room temperature. The intensive care team used this treatment under conditions that they considered well adapted until the imported specialty became available.

Aerodynamic analysis of hospital ventilation according to seasonal variations. A simulation approach to prevent airborne viral transmission pathway during Covid-19 pandemic

During the Covid-19 pandemic, location of the SARS-CoV-2 infected patients inside the hospital is a major issue to prevent viral cross-transmission. The objective of this study was to evaluate the risk of contamination through aerosol by using a global approach of the multiple environmental parameters to simulate, including seasonal context. A computational fluid dynamic (CFD) simulation based on the Lattice Boltzmann Method approach was used to predict airflow on the entire floor of a private hospital in Paris. The risk of contamination outside the rooms was evaluated by using a water vapor mass fraction tracker. Finally, the air contamination was estimated by a “cough model” producing several punctual emissions of contaminated air from potentially infected patients. In a winter configuration, the simulation showed a well-balanced ventilation on the floor and especially inside the rooms. After cough emissions from COVID-positive rooms, no significant contamination was observed in the circulation area, public waiting space and nurse office. On the contrary, in a summer configuration, the temperature difference due to the impact of the sun radiation between both sides of the building created additional air transport increasing the contamination risk in neighboring rooms and public spaces. Airborne spread was limited to rooms during winter conditions. On the contrary, during summer conditions, market airflow with potentially contaminated air coming from rooms located on the side of the building exposed to solar radiation was evidenced. These observations have implications to locate infected patients inside the building and for the conception of future health care structures.

Imported leishmaniasis in travelers: a 7-year retrospective from a Parisian hospital in France

BackgroundLeishmaniases are regularly seen in non-endemic areas due to the increase of international travels. They include cutaneous leishmaniases (CL) and mucocutaneous (MC) caused by different Leishmania species, and visceral leishmaniases (VL) which present with non-specific symptoms.MethodsWe reviewed all consecutive leishmaniasis cases seen between September 2012 and May 2020. The diagnostic strategy included microscopy after May-Grünwald-Giemsa staining, a diagnostic quantitative PCR (qPCR) assay, and species identification based on sequencing of the cytochrome b gene.ResultsEighty-nine patients had a definitive leishmaniasis diagnosis. Nine patients had VL with Leishmania infantum. Eighty patients had CL. Twelve patients acquired CL after trips in Latin America (7 Leishmania guyanensis, 2 Leishmania braziliensis, 2 Leishmania mexicana, and 1 Leishmania panamensis). Species could be identified in 63 of the 68 CLs mainly after travel in North Africa (59%) with Leishmania major (65%), Leishmania tropica/killicki (24%), and L. infantum (11%), or in West Sub-Saharan Africa (32%), all due to L. major. The median day between appearance of the lesions and diagnosis was 90 [range 60–127].ConclusionsOur diagnostic strategy allows both positive diagnoses and species identifications. Travelers in West Sub-Saharan Africa and North Africa should be better aware of the risk of contracting leishmananiasis.

The memory for words: Armand Trousseau on aphasia

ABSTRACT Of all the nineteenth-century physicians whose names still resonate today, Armand Trousseau is perhaps the one most familiar, for his description of carpal spasm as a sign of hypocalcemia (Trousseau’s sign) and his description of the hypercoagulable state associated with cancer (Trousseau’s syndrome). In the last three years of his life, Trousseau turned his attention to aphasia, which he included in his 1864 and 1865 lectures given at Hôtel-Dieu Hospital in Paris and which he discussed in an address to the Imperial Academy of Medicine in 1865. Trousseau preceded Wernicke in describing aphasia as a symptom complex, in which he included Broca’s aphemia, receptive aphasia, the inability to read with and without the inability to write (alexia with and without agraphia), the inability to name common objects (amnesic aphasia or anomia) and to recognize numbers (acalculia), and the inability to draw. Trousseau concluded that such a varied symptomatology could not arise from a single area, and he proposed that lesions of the posterior inferior frontal convolution identified by Broca, of the insula and corpus striatum and of the temporal and parietal lobes, could give rise to aphasia. The role of the posterior temporal lobe in receptive aphasia was confirmed by Wernicke in 1874, and the role of the inferior parietal lobule in agraphia and alexia was confirmed by Dejerine in 1891. Trousseau thought that aphasia resulted from the loss of the memory for words and for the synergistic actions of the movements of articulations learned in early childhood. Trousseau added inattention, lack of comprehension, and cognitive decline to amnesia as contributing factors to the verbal and nonverbal expression of thought. Trousseau constructed a comprehensive theory of aphasia that unified its semiology, localization, and pathophysiology. This construct had the virtue of being predictive and falsifiable by the clinico-pathological method. Through insight born of observation, Trousseau identified the issues that dominated aphasiology into the twenty-first century.

Joseph Raphaël Lalanne (1871–1930) : membre de la Société Médico-Psychologique (1901), médecin chef de l’asile de Maréville et son fils Jean Lalanne (1906–1978), médecin à l’asile des Bas-Foins (Partie I)

In the 19th century, the asylum of Maréville, a former municipality today integrated into Laxou (Meurthe-et-Moselle), was the most important of asylum for insane in France. Its population exceeded 1,800 patients. He received the insane from differently department : Meurthe-et-Moselle, Les Vosges, Haute-Saône, La Seine, Le Territoire de Belfort and the military district of Nancy. On the advice of Alphonse Marie Camille Fébvré (1853–1903) that was a chief physician officer of the Ville-Evrard asylum (1888), R. Lalanne worked his entire career in this etablishment of Meurthe-et-Moselle. He was born in the region of Gers (1871). In 1891, R. Lalanne was Bordeaux hospital extern. Two years later, he was Paris hospital extern. Thereafter, he was an intern of the asylums of the Seine (1894) and then an assistant doctor at the asylum of Maréville (1896). In the same year, he qualified as a medical doctor. He wrote his thesis on exhibitionism (1896); V. Magnan (1835–1916) was his doctoral supervisor. From March 1st 1898, he worked for the medical service of the boarding school Sainte-Anne (Maréville). He succeeded Alexandre Paris (1857–1933). In 1851, the teaching of psychiatry was introducted in Maréville well before that of V. Magnan (Paris). Fifty years later, R. Lalanne was an Assistant Professor of Psychiatry at the University of Nancy. In 1906, R. Lalanne was a chief physician of the public insane asylums and worked at the asylum of Maréville. Early on in his career, it was responsible for scientific missions on the study on the assistance of the insane in various European countries (Austria, Italy, Spain…). He was a member of learned societies; the Nancy medical society (1899), the Société Médico-Psychologique (1901), the clinical society of mental medicine (1926). He has served as president of the first society in 1924–1925. Lalanne is a founding member of the “Association amicale des Médecins des Établissements publics d’Aliénés de France” (1907) with Charles Vallon (1853–1924) and André Antheaume (1867–1927). With the dean of the faculty of Nancy Louis Spilmann (1875–1940), Lalanne initiated the use of the malariatherapy in the treatment of the General paralysis invented by Julius Wagner-Jauregg (1917). For many years, the Pavillon for this treatment where patients were in volontary hospitalization called Lalanne hospital. In honour of Raphaël Lalanne, the training center of the psychotherapeutic center of Nancy which bears His name at present.