Hernie De Amyand Compliquee De Gangrene De Fournier : A Propos D’un Cas Et Revue De La Litterature

La hernie de Amyand se définit par l'incarcération de l'appendice vermiculaire dans le sac herniaire. Elle constitue une entité rare. Nous rapportons le cas d’un patient de 75ans, éthylique, dénutri et porteur d’une cardiopathie ischémique stenté et sous traitement anticoagulant, admis pour une tuméfaction douloureuse et chaude localisée en région inguinale droite évoluant depuis cinq jours. Le bilan biologique révélait un syndrome infectieux et des troubles sévères de l’hémostase. Le scanner a objectivé un appendice perforé au sein du sac herniaire droit et un thrombus intraventriculaire gauche. L’évolution s’est faite vers une gangrène de Fournier. Après correction des troubles hémostatiques, la prise en charge chirurgicale a consisté en l’appendicectomie, drainage par laparotomie médiane associée à une orchidectomie droite sur un testicule nécrosé avec exérèse jusqu’en zone saine de la peau scrotale. Malgré des constantes stables en per-opératoire, le patient a présenté un arrêt cardiaque en post-opératoire immédiat, réanimé sans succès. Amyand hernia is defined by the presence of appendix herniating into the deep inguinal ring. It’s a rare condition. We report the case of a 75-yearold male patient, presenting alcoholism, undernutrition and ischemic cardiopathy which required angioplasty and anticoagulation, admitted for a painful and hot swelling in right inguinal region evolving for five days. Blood analysis revealed infectious syndrome and important hemostasis disorders. Computed Tomography scan showed perforated appendix herniating through inguinal ring associated to a thrombus in the left ventricle. The evolution was marked by a Fournier’s gangrene. After getting the normalization of the hemostasis values, a laparotomy was performed for appendicectomy, drainage. The right testicle, necrotized, was removed, with a wide debridement of the fasciitis. Although the parameters were stable during the surgery, the patient presente

Appendicite Aigue Gauche Sur Malrotation Intestinale: A Propos D’un Cas

L’appendicite aiguë est une urgence fréquente nécessitant une prise en charge chirurgicale en urgence. Dans sa forme typique, elle se manifeste par un syndrome d’irritation péritonéale en fosse iliaque droite. Toutefois, le tableau clinique est variable selon la localisation de l’appendice. Nous rapportons un cas d’appendicite gauche sur malrotation intestinale chez une patiente de 43ans, obèse, porteuse d’une uropathie malformative et multiopérée ; admise pour douleur en fosse iliaque gauche. Pas de fièvre, ni vomissement. L’examen clinique a retrouvé une irritation péritonéale en fosse iliaque gauche. Le bilan biologique a révélé un syndrome inflammatoire et une insuffisance rénale. Le scanner abdominal a permis de poser le diagnostic d’appendicite iliaque gauche sur mésentère commun complet. Elle a bénéficié d’une appendicectomie par laparotomie avec voie d’abord de Jalaguier gauche. Les suites opératoires ont été simples. L’appendicite sur mésentère commun complet est rare. Le diagnostic est basé sur le scanner abdominopelvien. Le traitement consiste en une appendicectomie idéalement par coelioscopie. Acute appendicitis is a common abdominal condition requiring emergency surgery. The typical manifestation is a peritoneal irritation in the lower-right quadrant of abdomen. However, this clinical presentation varies depending on the location of the appendix. Herein, we report a case of a left appendicitis on midgut malrotation in a 43-year-old obese patient with malformative and multi-operated uropathy; admitted with abdominal pain in the lower-left quadrant of the abdomen. No fever, no vomiting. The clinical examination revealed a peritoneal irritation in the left iliac fossa. The laboratory examination yieled an inflammatory syndrome and renal failure. An abdominal CT scan was performed and revealed a left iliac appendicitis on a complete common mesentery. An appendectomy was performed by laparotomy with left Jalaguier approach. The post-operative status wassimple. Appendicitis on complete common mesentery is rare. The diagnosis is based on the abdominal CT scan. The treatment is the appendectomy ideally through laparoscopy

Building a typology of cropping practices from comparison with a technical reference: first step for a relevant cropping system redesigning process – results for tropical citrus production

Introduction. Farm typologies and cropping practice typologies generally aim at seeking determinants of existing crop management strategies. They constitute the first step for setting improvement goals for cropping systems. Though there are a host of farm typology methods, few deal specifically with farmers’ practices, and even fewer investigate the correlations between practices. We propose here a framework for analysing the determinants of crop management, based on a vision of a crop management sequence condensed into logical combinations of cropping techniques. Materials and methods. This analytical framework was applied to the case of Guadeloupian citrus production, using a representative sample of 41 producers. Three stages were necessary to implement our analytical framework. At stage 1, logical and ordered combinations of cropping practices (CCPs), constitutive of observed as well as reference crop managements (RCMs), were identified through expert analysis. Based on measurements of deviations between farmers’ CCPs and RCMs’ CCPs, a typology of cropping practices was next built. At stage 2, the performances of farmers’ crop managements were evaluated using relevant indicators. Finally, at stage 3, constraints – either related to the environment or to the whole farm management – that determined producers’ cropping practices were identified for making, with the stakeholders, proposals for further technical improvements. Results. Crop management sequences were condensed into five CCPs. A technical profile was then determined for every producer, before a multiple correspondence factorial analysis was run. It identified two groups of producers with contrasting technical profiles. The collective analysis of these results pointed out “weed management” as a major constraint on the cropping systems, revealing that the RCM was inadequate in a context of impossible mechanisation. Discussion. Restructuring complex sequences of cropping techniques into five logical combinations of techniques enabled the comparison with a reference crop management. The cropping systems’ constraints and the objectives for further improvements were then set up collectively by the farmers and social stakeholders, along with the researchers. This analysis constitutes the first stage of a process of redesigning cropping systems, and its result provides a sound basis for a participatory approac

Meckel Diverticulum Causing Intestinal Volvulus

Intestinal volvulus is rare and responsible for upper bowel obstruction. They occur more frequently in a patient with abdominal surgery history. We report a case of small intestine volvulus on Meckel diverticulum, which occurred in a 21-year-old patient, with no history of laparotomy. The diagnosis confirmation was intraoperative, and the management consisted in a segmental resection of the small intestine with immediate anastomosis. The postoperative follow-up was good. This case underlines the scarcity and the severity of this presentation which therefore requires appropriate care in order to improve the prognosis

Primary Carcinosarcoma of the Spleen: A Rare Case Report of Incidental Finding after Splenic Trauma

Primary carcinosarcoma of the spleen is a rare, aggressive splenic malignancy. To date, seven cases have been reported in the literature. We report a first case of primary carcinosarcoma of the spleen in France. A 75-year-old woman with a medical history of hysterectomy for uterine adenocarcinoma presented with left hypochondrium pain following blunt abdominal trauma. A splenic mass was noted on computed tomography (CT) scan. A splenectomy was performed by laparotomy. Histology revealed a malignant mixed Mullerian tumor. The PET scan allowed us to confirm that it was a primary lesion of the spleen. She is currently undergoing adjuvant chemotherapy despite the tumor progression. The interest of this case lies in the rarity of primary carcinosarcomas of the spleen and the circumstances of its diagnosis

On-chip self-sensing function of 4x4 matrix micromachined resonating piezoelectric membranes for mass detection applications [biosensor/chemical sensor applications]

In this paper, we studied the dynamic behavior of micromachined piezoelectric membranes as an alternative to the QCMs biosensors. Contrary to FPW sensors that use progressive waves at the resonance, we use standing waves on our mechanical structures which allow us to obtain higher integration density. 4×4 matrixes of piezoelectric membranes use PbZr xTi1-xO3 (PZT) as piezoelectric film which geometries have been drawn by lift-off techniques. Each membrane (circular shaped, with a radius equal to 150 microns) can be individually addressed for actuation and/or sensing. Here we show that the same kind of membranes exhibit excellent self-sensing capabilities by using the direct piezoelectric effect of the PZT layer. The open-loop resonant frequencies of several membranes were measured by examining the self-induced charge on the sense electrode using a proximity electronics circuit. We simultaneously performed resonant frequencies measures by means of a dynamic optical interferometer that completely matched the electrical self-sensed resonant spectra. In this case the piezoelectric membranes were actuated in two different ways, either by using an external transducer or by using the self-actuating (reverse piezoelectric effect) capability of each membrane