Traumatismes hépatiques (épidémiologie lors des accidents de la route et physiopathologie)

Une lésion du foie est une cause potentielle de mortalité lors d un accident de la route. D une part, les conséquences corporelles des accidents de la route ont été colligées dans le département de la Côte d Or, avec un intérêt spécifique pour les lésions hépatiques. Une lésion abdominale était présente chez 14 % des blessés hospitalisés. Dix-sept pour cent des lésions abdominales intéressaient le foie. La présence d une lésion abdominale était un facteur de gravité des blessures. D autre part, un protocole expérimental était élaboré afin de connaître le comportement du foie lors d un choc. Des corps donnés à la science ont été soumis à des décélérations brutales frontales et latérales. Nous avons mis en évidence des caractéristiques non connus du comportement du foie en cas de choc et nous proposons des modèles de comportement. Une meilleur connaissance de l épidémiologie et de la biomécanique des lésions hépatique est indispensable afin d améliorer leur prévention.Hepatic injuries constitute a possible cause of death in motor vehicle crash. On the hand, an epidemiologic study collected all the injuries, with a special interest for the hepatic lesions, occurring in a road accident in the French administrative district of Côte d Or (Burgundy). An abdominal lesion was found in 14 % of the wounded. Liver was affected in 17 % of abdominal trauma. Hepatic injury appeared as a factor of gravity. On the other hand, we conducted a biomechanical experiment in order to investigate the behaviour of the liver during deceleration. Post mortem human subjects were subjected to frontal or lateral decelerations. Our results showed unknown features of the abdominal impact responses. We are able to propose new patterns of hepatic biomechanics. Better understanding of epidemiology and biomechanics of the hepatic trauma is required for improving their prevention.DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Identification of Prognostic Factors Determining Risk Groups for Lung Resection

Background. Pulmonary resection belongs to a group of surgical procedures with significant morbidity and mortality. The aims of this study were to classify postoperative complications and to identify prognostic factors determining risk group. Methods. In a prospective study 500 patients undergoing lung resection (wedge resection, n � 141; lobectomies, n � 245; bilobectomies, n � 12; and pneumonectomies, n � 102) were included. In 178 patients (36%) pulmonary resections were extended to structures or thoracic organs. Sleeve resection of the bronchus to preserve lung parenchyma was performed in 22 patients. Results. Classification of postoperative complications fell into four categories: patients without postoperative complications; patients with moderate complication

Celiacomesenteric trunk: a variation that must be known before aortic surgery

The celiac trunk and the mesenteric arteries may present variations with different clinical significance. A celiacomesenteric trunk was discovered in a patient with mesenteric ischemia and a history of aortic bypass without inferior mesenteric artery reimplantation. Despite thrombectomies and digestive resections, the patient died. Anatomic variations like celiacomesenteric trunk must be known before aortic surgery

Incontinence anale : ne pas baisser les bras !

Incontinence anale : ne pas baisser les bras !. Printemps médical de Bourgogn

On liver modelling under trauma situations

Thoracic and abdominal organs are typically severely injured during crash situations leading to severe traumas with high morbidity. To prevent this, the definition of efficient safety devices should be based on a detailed knowledge of injury mechanisms and related injury criteria. To this end, finite element (FE) simulation coupled to experiment could be a valuable tool to provide a better understanding of internal organ behaviour. This preliminary study aims to improve FE modelling focusing on the mechanical behaviour of the liver. It concerns the identification of structure mechanical properties up to the evaluation of damage occurrence. This work furthers the building of a methodology to implement liver behaviour in a FE model that is robust enough to encompass the biological, intrinsic and experimental variabilities. It is based on an ongoing experimental characterization of the liver under quasistatic compression. A first set of model parameters relevant to the subinjury level has been obtained. Subsequent damage evaluation was performed through von Mises level analysis by comparison to the experimental tests including necropsies and histological structure analysis. Results revealed that damage was centred in the middle part of the right lobe. This work moves us closer to a complete understanding of injury mechanisms incorporating clinical data concerning liver traumas. Abdominal organs, damage evaluation, FE simulation, inverse analysi

Schools of journalism facing participative Web 2.0

This article looks at how students and teachers at four schools of journalism from Grenoble and Marseille (France), Bucharest (Romania) and Geneva (Switzerland),1 represent and make use of amateur online publishing practices. It analyses the current conflict between the values associated with Web 2.0 and the normative model underpinning journalism, which is historically rooted in opposing the figure of the amateur. Combined research methods were used in the study, such as a questionnaire carried out on a group of 85 first-year master's students in journalism, semi-structured interviews with second-year students and teachers, and focus groups conducted among volunteer students. The survey's results highlight the role played by training establishments in legitimizing and internalizing the standards of journalistic professionalism

Naviguer dans les traces numériques sur Twitter. Retour sur la conception d'un dispositif de cartographie de données à destination de journalistes

International audienceCet article offre un retour d’expérience d’une recherche appliquée pluridisciplinaire pour concevoir un outil d’exploration et de cartographie de données issues de Twitter à destination des journalistes. L’approche privilégie l’observation et la compréhension des usages des journalistes et une projection d’intégration du logiciel dans leurs pratiques et les routines quotidiennes. Trois scénarios d’usages sont développés, rendant compte d’une diversité d’appropriation de l’outil. Ils soulignent l’intérêt de penser une interface favorisant la compréhension par l’utilisateur des opérations réalisées sur les données, mais également la nécessité que les usagers disposent d’une culture numérique minimale pour produire des contenus éditoriaux fondés sur l'exploitation des traces numériques

Interposition of a gastric pouch between ileum and anus after proctocolectomy: long-term results in 3 patients.

International audienceBACKGROUND: After proctocolectomy, ileal pouch-anal anastomosis may not be feasible, especially in the case of desmoid tumor or after failed ileal pouch-anal anastomosis requiring excision of the pouch. We designed a gastric pouch interposed between the terminal ileum and the anus to avoid a permanent ileostomy for these patients. Long-term results and quality of life with this technique remain unknown. METHODS: After proctocolectomy, ileal pouch-anal anastomosis was not feasible or had failed in 3 patients (2 with familial adenomatous polyposis and 1 with ulcerative colitis; 40, 49, and 50 years of age, respectively). Of these patients, 2 had undergone end ileostomy 7 and 8 years previously. A pouch was created using the left half of the gastric fundus, supplied through the right gastroepiploic vessels; the pouch was anastomosed proximally to the terminal ileum and distally to the anus. Diverting ileostomy was performed in all patients. RESULTS: After a mean follow-up of 6 years, all 3 patients were highly satisfied with the operation and described their quality of life as good. The median stool frequency during the day and night were 6 and 1, respectively. No patient reported incontinence or urgency. Of the 3 patients, 2 had minimal soiling with gastric juice; 1 patient had anastomotic ulcers with bleeding requiring resection with reanastomosis. All of the patients needed long-term proton pump inhibitor therapy and topical perianal treatment to prevent skin burning. CONCLUSION: Inter-ileoanal gastroplasty is a surgical salvage technique that can avoid a permanent ileostomy. The procedure provides a good quality of life for patients with unfeasible or failed ileal pouch

Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs.

International audienceBACKGROUND: Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of great concern. During closed-abdomen HIPEC, operating room staff are not exposed to drugs, but the distribution of the heated liquid within the abdomen is not optimal. With open-abdomen HIPEC, the opposite is true. Although the open-abdomen method is potentially more effective, it has not become a standard procedure because of the risk of exposure of members of the team to drugs. METHODS: We present a new technique (closed HIPEC with open abdomen) which ensures protection against potentially contaminating exposure to liquids, vapours and aerosols, and allows permanent access to the whole abdominal cavity. Its principle is to extend the abdominal surgical wound upwards with a sort of "glove-box". The cutaneous edges of the laparotomy are stapled to a latex "wall expander". The expander is draped over a special L-section metal frame placed above the abdomen. A transparent cover containing a "hand-access" port, like those used in laparoscopic surgery, is fixed inside the frame. RESULTS: In 10 patients, this device proved to be hermetic for both liquids and vapours. Intra-abdominal temperature was maintained between 42 and 43 degrees C during most of the procedure. The whole abdominal cavity was accessible to the surgeon, allowing optimal exposure of all peritoneal surfaces. CONCLUSION: This technique allows optimal HIPEC, while limiting the potential toxic effects for the surgical, medical and paramedical teams

Comparison of the biomechanical behaviour of the liver during frontal and lateral deceleration

The trunk of a car occupant can be injured by a frontal or lateral impact. Lesions can be either intrusion injuries or due to the effects of deceleration alone. The aim of this study conducted with human cadavers was to explore the effects of deceleration on the liver during frontal or lateral deceleration