A case of epistaxis

International audienceThe authors report a case of epistaxis in a 74-year-old male patient. His recent medical history documented recurrent nasal bleeding and a Le Fort 1 osteosynthesis 3 weeks before admission to our unit. A CT scan revealed a left descending palatine artery pseudoaneurysm in the left maxillary sinus, that was successfully embolized. Pseudoaneurysms of the internal maxillary artery and its branches are rare life-threatening complications. This diagnosis should be considered when confronted to recurrent head and neck bleeding, especially in a context of recent maxillo-facial trauma or surgery. Embolization should rapidly be implemented

Contribution of the periosteum to mandibular distraction - Fig 1

<p>A: Picture of the tensile test apparatus. The elongation procedure were recorded with a high resolutionvideo camera. The speckled periosteal sample can be seen between the grips of the machine. B: Example of axial strain homogeneity on sample n°12. Tensile tests were recorded, and Lagrange deformation fields were calculated using digital image correlation. The Vic-2D parameters used to perform this analysis included a step of 3 pixels, Gaussian subset weights, optimized 8-tap interpolation, normalized square differences, and incremental correlation. The consistency threshold was set at 0.05 (maximum margin), the maximum confidence margin was 0.05. In this figure, the axial strain (<i>e</i>_<i>xx</i>) is displayed with a colour scale.</p

Contribution of the periosteum to mandibular distraction

<div><p>Mandibular distraction is a surgical process that progressively lengthens bone. To improve the distraction procedure and devices, the load of distraction and the mechanical strain of soft tissues during the process must be determined. We tested the assumption that it could be the periosteum primarily opposing distraction. Therefore we assessed the mechanical properties of the human mandibular periosteum and compared the stress-strain data with the torque measured on the activator during a cadaveric mandibular distraction. A 20 mm horizontal mandibular distraction was performed in 7 cadavers using standard distractors. Torque was measured with a torquemeter placed on the activation rods of the devices, providing a load (<i>L</i>_<i>t</i>) for each millimeter of distraction. In parallel, 18 periosteum samples were harvested from 9 cadaver mandibles. Uniaxial tensile tests were performed on the specimens and an estimated load (<i>L</i>_<i>c</i>) was calculated using periosteal stress-strain data and mandibular dimensions. During the distraction process, we observed an increase of the load <i>L</i>_<i>t</i> from 11.6 to 50.6 N. The periosteum exhibited a nonlinear viscoelastic stress-strain relationship, typical of biological tissues composed of collagen and elastin. The median <i>L</i>_<i>c</i> and <i>L</i>_<i>t</i> were not significantly different for the first millimeter of distraction. We demonstrated the periosteum is primarily responsible for opposing the distraction load.</p></div

The grey points (⋅) corresponds to all <i>L</i>_<i>t</i> for all cadavers plotted against the length of the distraction during a 20 mm distraction.

<p>The black squares (□) are the medians of the load estimates calculated for each millimeter.</p

Phase 1 stress-strain curves.

<p>The axial stress <i>σ</i> (in MPa) is displayed against the axial strain <i>ε</i>. Dark lines represent the linear fits of <i>E</i>_<i>toe</i> and <i>E</i>_<i>steep</i> for sample <i>n</i>°12. We observed typical non-linear stress-strain curves with a toe region, a heel, and a linear steeper phase. Curves of all samples are represented with grey ×.</p

Moduli of the steep linear region of the stress-strain curves in phase 1 (<i>E</i>_<i>steep</i>), <i>ε</i>₀ strains, <i>σ</i>₀ pre-stresses, <i>τ</i>₁ and <i>τ</i>₂ characteristic times, stress-strain and torque-based loads (<i>L</i>_<i>c</i> and <i>L</i>_<i>t</i>) are displayed for each periosteal sample and the corresponding cadaver.

<p>Moduli and pre-stress values are in megapascals (MPa). Characteristic times are in seconds (s). <i>L</i>_<i>c</i> and <i>L</i>_<i>t</i> loads are in newtons (N). Displayed <i>L</i>_<i>t</i> values are for the first millimeter of distraction (<i>s</i> = 1 mm). Loads were compared using a Wilcoxon signed-ranks test for paired samples. SEM: standard error of the mean IQR: interquartile range ⋆: calculated for cadaver III to IX. †: <i>L</i>_<i>c</i>-<i>L</i>_<i>t</i> comparison.</p

Thickness value of the periosteum measured on histological cross-section slides (averaged on 5 random thickness measures for each samples).

<p>Thickness value of the periosteum measured on histological cross-section slides (averaged on 5 random thickness measures for each samples).</p

Relaxation curves.

<p>All samples are represented (grey points); the dark line represents the bi-exponential fit for sample <i>n</i>°12. The axial stress <i>σ</i> (in MPa), normalized with the maximum axial stress of the sample <i>σ</i>_<i>max</i> obtained at the end of phase 1 is displayed against time (in s). The following function was used to fit the relaxation curves: <i>R</i>² > 0.983. It has to be noted that one sample relaxation stopped at 200 s for technical problem. We assume that the relaxation was long enough to perform a bi-exponentional fit.</p

Oral migration of

We report an autochthonous case of oral dirofilariasis in a 46-year-old female patient exposed in South-Eastern France. The patient first presented eyelid creeping dermatitis of one-week duration, then a sub-mucosal nodule appeared in the cheek. The entire nodule was removed surgically. Histologically, the nodule appeared as inflammatory tissue in which a worm was seen. The molecular analysis, based on cox1 and 12S sequences, identified Dirofilaria repens. Ivermectin treatment was given prior to diagnosis, while taking into consideration the most common causes of creeping dermatitis, but treatment was ineffective. The oral form of dirofilariasis is uncommon and could lead to diagnostic wandering

'Yellow vest" social protests: a new era of facial injuries induced by rubber bullet from non-lethal hand-held weapons

International audienceSince November, 2018, France has been facing violent contestation with the national so-called yellow vests protests, resulting in about 4000 casualties.1 We managed 21 patients who presented with face and eye injuries caused by rubber bullets from non-lethal hand-held weapons (NLHHWs). Because of the steady increase in the overall number and violence of protests worldwide,2 one might expect a rise in injuries caused by NLHHWs