ANEVRISME ROMPU DE L’ARTERE GASTRODUODENALE : HEMOSTASE PAR EMBOLISATION

Aneurysms of the gastroduodenal artery are rare vascular lesions with significantly higher risk of rupture, given the predominance of inflammatory causes. Rupture is frequently the initial symptom, and intraoperative isolation and control of the aneurysm can be difficult, it worsens the prognosis and increases mortality. The endovascular approach with embolization of the aneurysm offers in these cases the possibility of a primary hemostasis and allows secondly evacuation of the hemoperitoine on a stable and a well-prepared patient.We report a 72 year-old women, having benefited of an urgent haemostasis by embolisation of a ruptured gastroduodenal artery aneurysm and a secondary evacuation of her hemopéritoine 48 hours later. It was an embolization in a ruptured digestive artery aneurysm with an anatomic variant, the hepatic artery was arising from the superior mesenteric artery, and it makes all the particularity of this observation. In this paper we recall the diagnostical and etiological aspects of gastroduodenal artery aneurysms, we discuss the difficulties of their treatment and we emphasis the advantages of embolization in management of this type of complication.Les anévrismes de l'artère gastroduodénale sont des lésions vasculaires rares, la rupture en est un risque réel, il est significativement augmenté par la nature inflammatoire dominante de leurs étiologies. La rupture est un mode de révélation fréquent et souvent inaugurale, elle rend le contrôle chirurgical de l’artère gastroduodénale difficile, aggravant ainsi le pronostic et augmentant le taux de mortalité. L’approche endovasculaire par embolisation offre la possibilité d’une hémostase primaire en urgence et permet de reporter l’évacuation de l’hemopéritoine dans un deuxième temps sur un malade stable et bien préparé.Nous rapportons l'observation d'une femme de 72 ans, ayant bénéficiée d’une hémostase par embolisation d’un anévrisme rompu de l‘artère gastroduodénale en urgence et d’une évacuation secondaire de son hemopéritoine 48 heures après. Cette observation rapporte le cas d’une embolisation sur un anévrisme rompu d’une artère digestive avec une variante anatomique réalisée par l’artère hépatique qui nait de l’artère mésentérique supérieure, cela fait toute la particularité de cette observation. Dans ce travail nous rappelons les aspects diagnostic et étiologiques des anévrismes de l’artère gastroduodénale, nous discutons les difficultés de leur prise en charge en cas de rupture et nous mettant le point sur les avantages de l’embolisation primaire à visée hémostatique

Social workers’ contribution to success in lives of young Moroccan-Dutch

In two studies we investigated the views of Dutch social professionals and young Moroccan-Dutch on success and failure factors in the social participation of the latter group in the Netherlands. In the first study, professionals (N = 148) emphasized ties and life skills. In the second study, we compared perspectives on participation via interviews with Moroccan-Dutch (N = 61), aged 18–34 years, and Dutch social workers (N = 45), aged 20–64 years. Both emphasized inclusion, integration, schooling, skills, working harder than mainstream Dutch, positive feedback, the relationship of trust and motivation. However, participation is hampered by stigmatization, victim-blaming attitude, poor parenting, weak skills, limited ties and access to social work. Weak ties with mainstreamers were due to exclusion according to professionals and to cultural barriers according to Moroccan-Dutch. We found differences, using chi-square tests, in engagement with co-ethnics, native Dutch or a mixed group, education, SES and between successful and unsuccessful Moroccan-Dutch. Professionals advised not to focus on the anti-immigrant climate as this is resistant to short-term change but underlined combatting exclusion. Moroccan-Dutch respected professionals who supported them unconditionally. Their participation associates with ‘social Triple C’: climate, capital and competence. Strengthening these resources is the best intervention for successful participation