Le lambeau bifolié en reconstruction des pertes de substance superficielles du nez (Etude d'une série de 133 cas)

La reconstruction des pertes de substance nasales est connue depuis des temps immémoriaux. Parmi les différentes techniques connues, le lambeau bifolié (ou bilobé) a été décrit il y a près d'un siècle. Pourtant son utilisation reste confidentielle, malgré les améliorations successives apportées par divers auteurs. Ce travail est une étude rétrospective portant sur 131 patients, soit 133 cas de reconstructions de pertes de substance superficielles du nez par lambeau bifolié. Nous aboutissons aux conclusions suivantes : Quel que soit le type de lambeau bifolié utilisé, tous les patients opérés sont satisfaits de leur prise en charge, avec une majorité de résultats esthétiques satisfaisants et très satisfaisants ; Le lambeau bifolié selon Zitelli donne globalement de meilleurs résultats que le lambeau bifolié selon Esser et Zimany, en particulier dans les localisations critiques comme l'aile narinaire, la pointe et la suprapointe ; Le diamètre des pertes de substance pouvant être comblées par un lambeau bifolié est plus important que ce qui est décrit dans la littérature (jusqu'à 25 mm dans notre étude avec de bons résultats) ; Deux paramètres géométriques sont importants afin d'éviter les anomalies de contours : l'angle total de rotation du lambeau, et l'angle formé entre le lobe secondaire et l'axe narinaire ; L'utilisation du lambeau bifolié ne se limite pas à la partie inférieure du nez: de bons résultats esthétiques sont obtenus sur le dorsum nasal, les faces latérales et même au niveau de la racine du nez, du canthus interne et de la vallée des larmes. Le lambeau bilobé est idéal en reconstruction des zones critiques du nez comme l'aile narinaire, la pointe et la suprapointe. Il donne également des résultats satisfaisants sur le reste de la pyramide nasale. Il devrait plus souvent être envisagé dans les reconstructions de pertes de substance nasales allant jusqu'à 25 mm de diamètre .NANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Baden-Wurtemberg (Alemania). Operaciones bélicas. [18--?] (1796). 1:102171

Relieve : líneas perpendiculares normalesColoreadas a mano las posiciones de los ejércitosInserta cuadro con el desarrollo de la batallaAl márgen inferior derecho figura : n 44Copia digital. España : Ministerio de Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

Oncological safety of nipple-sparing prophylactic mastectomy: A review of the literature on 3716 cases

INTRODUCTION: The objective of our study was to evaluate the risk of cancer after prophylactic nipple-sparing mastectomy (PNSM). MATERIAL AND METHODS: The PubMed database was consulted using the following key-words: "nipple-sparing mastectomy", "prophylactic", "locoregional recurrence", "oncological risk". Articles published between January 1995 and December 2016 were searched. RESULTS: Out of the 270 articles found, 19 were included. Overall, 15 studies were retrospective, 2 prospective, 2 prospective and retrospective and 3 were multicentric. All told, they involved 3890 patients corresponding to 6786 mastectomies, among which the total number of prophylactic nipple-sparing mastectomies was 3716. Average age of the patients was 44.4years and average follow-up was 38.4months (8-168months); 29.4% of them had a BRCA 1 or 2 mutation; 85 and 15% underwent prosthetic and autologous reconstructions, respectively. Average cancer rates exterior to and within the nipple areolar complex (NAC) were 0.2 and 0.004%, respectively. The overall average rate of histological pre-malignant lesions in the nipple areolar complex was 1.5%. The overall complication rate was 20.5%, and necrosis rates of the nipple areolar complex and the skin were 8.1 and 7.1%, respectively. CONCLUSION: In prophylactic breast surgery, conservation of the nipple areolar complex does not seem to increase the risk of cancer development. However, short follow-up time and the different methodologies applied in the different studies presently preclude generalization of the technique

Référentiel environnemental et socio-économique des systèmes d'élevage porcins conventionnels français

National audienceThis study aims to produce multicriteria environmental figures (using Life Cycle Assessment, LCA) associated with socioeconomicindicators for different types of pig units representative of the main French production standards. Eight systems are assessed,defined by their size, the degree of specialization and the location of the pig unit, the slurry management and the pig feedingstrategy. The results are expressed per kilogram live pig produced at the farm level, and the field for Life Cycle Analysis includesproduction and supply of inputs, construction of buildings, pig breeding and management of slurry. These reference standardsprovide a picture of the socioeconomic and environmental performance of French pig production systems and of their variabilitybetween and within systems. The environmental results make it possible to identify the most strategic and easily attainableoptions of improvement. The efficiency of different strategies is evaluated in connection with feed formulation, improvement ofanimal performance, and the implementation of recommended good environmental practices. The socioeconomic indicators showthe various levels of access to the action levers

Référentiel environnemental et socio-économique des systèmes d'élevage porcins conventionnels français

Session : EnvironnementNational audienceThis study aims to produce multicriteria environmental figures (using Life Cycle Assessment, LCA) associated with socioeconomicindicators for different types of pig units representative of the main French production standards. Eight systems are assessed,defined by their size, the degree of specialization and the location of the pig unit, the slurry management and the pig feedingstrategy. The results are expressed per kilogram live pig produced at the farm level, and the field for Life Cycle Analysis includesproduction and supply of inputs, construction of buildings, pig breeding and management of slurry. These reference standardsprovide a picture of the socioeconomic and environmental performance of French pig production systems and of their variabilitybetween and within systems. The environmental results make it possible to identify the most strategic and easily attainableoptions of improvement. The efficiency of different strategies is evaluated in connection with feed formulation, improvement ofanimal performance, and the implementation of recommended good environmental practices. The socioeconomic indicators showthe various levels of access to the action levers

Référentiel environnemental et socio-économique de systèmes d'élevage porcin conventionnels français -Base pour le pilotage d'une amélioration environnementale

Ce numéro de la revue Innovations Agronomiques est dédié aux articles issus des programmes Casdar 2008-2010National audienceTo help pig husbandries to improve their environmental results, this study aims at producing a referencetable from 16 types of pig breedings: 8 are representative of existing systems in France, and 8 are imagined systems built on the basis of an environmental optimization. The reference table provides the assessment of environmental impacts of a kilogram of pig at farm gate (by Life Cycle Analysis (LCA)), and socioeconomic indicators of the breeding. The results make it possible to identify the most strategic steps of the life cycle of the pig production to be improved and which are accessible to the breeders. It was also possible to identify environmental efficiency of various strategies concerning feed and manure management, and diverse implementations of environmental best practices. The socioeconomic indicators show the various levels of access to the action levers.Pour aider les élevages porcins à améliorer leur bilan environnemental, cette étude vise à produire unréférentiel à partir de 16 élevages porcins types : huit représentatifs des systèmes existants dominantsen France, et huit systèmes évolués construits sur la base d’une optimisation environnementale. Leréférentiel fournit pour chacun une estimation des impacts environnementaux d’un kilogramme de porcvif en sortie d’exploitation (par Analyse de Cycle de Vie (ACV)), et des indicateurs socio-économiquesde l’atelier porcin. Les références obtenues permettent d’identifier les postes les plus stratégiques,accessibles aux éleveurs, sur lesquels faire porter les améliorations, et les efficacités environnementales de différentes stratégies d’alimentation et de gestion des déjections et de la mise en place de bonnes pratiques environnementales. Les indicateurs socio-économiques des systèmes pointent sur les différents niveaux d’accès aux leviers d’action

SARS-CoV-2 vaccination modelling for safe surgery to save lives: Data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population