Luca Paltrinieri, La sanction éducative. Une recherche-action

Par un récit vivant, enrichi de nombreux passages didactiques, l’auteur nous entraine dans une aventure, celle d’un parcours de recherche-action au sein des écoles de la Chambre de Commerce et d’Industrie de Paris (CCIP). Les formations dispensées par cet organisme, qui comprend au total onze écoles, débouchent sur des hauts niveaux de qualification, mais aussi, sur des métiers plus modestes tels que le floréal, l’horticulture, et l’aménagement du paysage. Ces dernières filières concernent un..

Béatrice Brauckmann, Salim Behloul, L’intérêt de l’enfant. Genèse et usages d’une notion équivoque en protection de l’enfance

Au moment où de nombreux experts se penchent sur l’application de la loi de mars 2016 réformant la protection de l’enfance et où des chercheurs mènent des travaux « avec les enfants », deux spécialistes ont décidé de placer le focus sur une notion aussi essentielle que problématique : celle de « l’intérêt de l’enfant ». Certes, le sujet a déjà été beaucoup traité dans les années 1980/90 ; cependant, vu l’empilement de réformes et de dispositifs qui, depuis cette période, transforment le champ..

Paraplegia as a symptom of failure after endovascular therapy of type B aortic dissection in Marfan syndrome

This report describes successful treatment of an unusual case of concomitant paraplegia and type 1 endoleak during the early postoperative course of endovascular therapy of type B dissection in a patient with Marfan syndrome

Inferior Mesenteric Artery Stenting as a Novel Treatment for Chronic Mesenteric Ischemia in Patients with an Occluded Superior Mesenteric Artery and Celiac Trunk

IntroductionChronic mesenteric ischemia (CMI) is a challenging problem, with revascularization the mainstay of treatment. Management of CMI is especially challenging in the patient with superior mesenteric artery (SMA) and celiac artery (CA) occlusions.ReportWe report a case series of four patients with chronic mesenteric ischemia who were not candidates for CA or SMA revascularization who were successfully treated with inferior mesenteric artery (IMA) angioplasty and stent placement to improve collateral circulation and palliate symptoms.DiscussionTo our knowledge, this is the largest case series to date reporting the use of an IMA stent to improve collateral circulation in patients with CMI

Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms

AbstractStudy Design: This study was a prospective monocentric study to assess the safety and effectiveness of percutaneous embolization with coils of postcatheterization femoral pseudoaneurysm (PCFP). Patients and Methods: Seventeen PCFPs of 32-mm mean diameter in 16 patients were embolized while anticoagulant or antiplatelet therapy was maintained. Ultrasound scan-guided compression repair failed at least one time in 13 cases and was contraindicated in the four remaining cases. With ultrasound-Doppler scan guidance, the PCFPs were percutaneously punctured with a 16-gauge intravenous catheter. An angiogram was performed through the catheter to ensure its location within the sac. Stainless steel spring coils with synthetic fibers were introduced within the PCFP with fluoroscopic control. Successful thrombosis was checked with ultrasound-Doppler scan and was repeated at days 1, 30, and 180 when possible. Results: All PCFPs of 32-mm mean diameter were successfully treated with two to nine coils. After embolization, gentle additional compression was necessary for complete occlusion, with a mean duration of 6.3 minutes (range, 0 to 15 minutes), except in one case with treatment with abciximab in which it was 45 minutes. All procedures were uneventful and painless. The mean follow-up period was 9.5 months (range, 1 to 21 months). Two recurrences (11.7%) were observed, and one was successfully treated with a second embolization. Conclusion: Percutaneous embolization with coils appears to be a safe and effective method for treatment of PCFP. It may be performed in patients undergoing anticoagulant or antiplatelet therapy and must be attempted when ultrasound scan-guided compression repair has failed or is contraindicated. (J Vasc Surg 2002;36:127-31.

New Bacteriological Patterns in Primary Infected Aorto-iliac Aneurysms: A Single-centre Experience

AbstractObjectivesTo assess causative pathogens and surgical outcomes in patients with primary infected aorto-iliac aneurysms at our institution.DesignRetrospective study of patients treated at a university hospital between 1992 and 2009.ResultsWe identified 26 patients (median age, 63 years) with primary infected aneurysms on the aorta (descending thoracic, n = 2; thoraco-abdominal, n = 3; suprarenal, n = 2; infrarenal, n = 15) or iliac arteries (n = 4). Among them, 22 were symptomatic, including 13 with ruptured aneurysms. The causative organisms, identified in 25/26 patients, were Campylobacter fetus, n = 6; Streptococcus pneumoniae, n = 4; Listeria, n = 3; Salmonella, n = 2; Mycobacterium tuberculosis, n = 2; Staphylococcus aureus, n = 1; and other, n = 7. Immune suppression was a feature in 10 (38.4%) patients. Revascularisation was performed in situ in 23 patients (10 allografts, eight grafts, three superficial femoral veins, and 2 stentgrafts) and by extra-anatomic bypass in three patients.Hospital mortality was 23% (in situ group, 17.4%; extra-anatomic group, 66.7%; χ2 Yates, P = 0.24). During follow-up in the 20 survivors (median, 48.5 months), there were two non-infection-related deaths (five and 24 months) and six (30%) vascular complications.ConclusionsThe bacteriological spectrum of primary infected aorto-iliac aneurysms was wider than previously reported. The availability of new diagnostic tests and increased prevalence of immunosuppression may explain this finding

La loi du 27 juillet 1942 ou l'issue d'une querelle de monopole pour l'enfance délinquante

La loi du 27 juillet 1942 fut conçue pour régler les insuffisances de la législation de 1912 dans le contexte de désorganisation sociale de la Deuxième Guerre mondiale. Son élaboration fut le résultat d'une concurrence entre deux catégories d'acteurs impliqués dans la protection de l'enfance. Alors qu'il était une prérogative de l'Éducation surveillée, le traitement de l'enfance délinquante fut convoité par une partie du secteur associatif socio-judiciaire, sous la pression des politiques familiales du régime de Vichy. L'Éducation surveillée conserva le traitement de l'enfance délinquante au prix d'un effort stratégique. Le compromis fut un arrangement pragmatique de coordination imposé par souci d'économie. Effacée des mémoires du législateur, cette loi, peu appliquée, puis abrogée, n'en constitue pas moins une étape dans l'histoire de la construction du dispositif. Elle préfigure sur de nombreux points les dispositions de l'ordonnance de 1945.The law of 27th July 1942 analysed as the result of a quarel about the monopoly of treatment of juvenile delinquency. The law of 27th July 1942 was passed in the context of social disorganisation of the second world war.Michèle-Becquemin-Girault shows how the elaboration of this law was the result of competition between two categories of child protection authorities. The treatment of juvenile delinquency was up until then a prerogative of a public body "l'Éducation surveillée". At that time it became also coveted by private social and educational institutions backed by the family policy of the Vichy government. Through a strategic effort, the public department of "Éducation surveillée" kept the treatment of juvenile delinquency for itself. A compromise was found between the two parties by a pragmatic proposal of coordination imposed by the economic realities of the time.This law marked a step in the history of the construction of the actual system of treatment of youth delinquency. Many of its clauses were kept in the 1945 reform

Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

Background: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods: An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. Results: The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. Conclusion: The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.</p