Fractures De La diaphyse humérale Une étude rétrospective comparative de technique HACKETHAL Vs plaque vissée : A propos de 19 cas

Introduction: They represent 2% of all fractures. The main debate around recent fractures focuses on the therapeutic indications for all types of surgical stabilization have sometimes unconditional and strident defenders. Material and Methods: A series of 19 osteosynthesis was reviewed: 4 with other traumas, 1 case of skin incision and two initial radial nerve palsy. The osteosynthesis by plate was performed in 7 patients and by bundle pinning in 12 patients. The outcome evaluation was made with the listing for Stewart & Hundley amended. Results: For patients treated with plate: 2 postoperative radial nerve palsy. There were 1 non- union and no case of sepsis.71, 4% of patients had good and excellent results. For patients treated by bundle pinning: no radial nerve palsy, 1 case of non-union, and no cases of sepsis, under-acromial conflict, or of pin protrusion in the top. Good and very good results concerned 91, 7% of patients. Conclusion: The choice of therapeutic methods is difficult. There is no method that could lead to unanimous. The bundle pinning fixation could be this method, but the risk of stiffness of the shoulder is a feared complicationIntroduction Elles représentent 2% de l’ensemble des fractures ; Le débat principal autour des fractures de la diaphyse humérale se centre sur les indications thérapeutiques car tout type de stabilisation chirurgicale trouve des défenseurs parfois inconditionnels et véhéments. Matériels et Méthodes : Une série de 19 ostéosynthèses a été revue dont 4 polytraumatisés, 1 cas d’ouverture cutanée et deux paralysies radiales initiales. L'ostéosynthèse par plaque a été réalisée chez 7 patients et par embrochage fasciculé chez 12 malades. L’évaluation des résultats s'est faite avec la cotation de Stewart & Hundley modifiée. Résultats Pour les patients traités par plaque : Deux paralysies radiales post-opératoires, pas de pseudarthrose, pas de cas de sepsis. Les bons et très bons résultats concernent 71,4% des patients. Pour les patients traités par embrochage : pas de paralysie radiale ; 1 cas de pseudarthrose, pas de cas de sepsis, aucun cas de conflit sous acromiale ou de protrusion du clou en haut. Les bons et très bon résultats concernent 91,7% des patients. Conclusion Le choix entre les méthodes thérapeutiques est difficile. Il n'existe pas de méthode pouvant entraîner une adhésion unanime. L'embrochage fasciculé pourrait être cette méthode, mais le risque de raideur de l’épaule en fait une technique redoutée. L'ostéosynthèse par plaque aussi pourrait l’être mais son principal reproche est l’atteinte neurologique

Characterization of far-field and near-field exposure of the population for RF-EMF in realistic configurations of ICT usages

International audienceThe study presented in this paper is part of a larger study within the European FP7 project LEXNET framework. The project LEXNET aims at considering new technologies and architectures for minimizing the global exposure of a population to radiofrequency electromagnetic fields. In the framework of the project a new exposure metric named Exposure Index (EI) is proposed. The EI quantifies the global exposure of a population induced by both mobile devices and base station antennas or wireless access points. The EI requires a set of SAR values (whole-body and local-body) for typical postures and usages of mobile devices in a population. In our study, we assessed these SAR values by 3D electromagnetic simulations. We used an adult and a child numerical model in two postures (sitting and standing) and in three usages (voice, data and laptop).The whole-body SAR for each exposure configuration was evaluated at four different frequencies (400, 900, 1940 and 2600MHz).</p

Évolution dans le temps et déterminants de l’entrée dans la filière de prise en charge « idéale » de l’infarctus aigu du myocarde. Étude EFIM

International audienceIntroductionAcute myocardial infarction outcome is strongly related to time of reperfusion. Since 2006, an early call to the SAMU is recommended. However, many patients escape this “ideal” way.ObjectiveTo study the evolution and determinants of entry into the “ideal” chain of care.MethodsAnalysis of the data of a prospective register of 8 SAMUs and 39 Mobiles Intensive Care Units in Île-de-France. Inclusion: patient with ST-elevated myocardial infarction with (STEMI) of less than 24 hours managed in prehospital settings. Criteria: age, gender, call by general practitioners (GP), management time, coronary reperfusion decision. Analysis by district characterized by: position vs. Paris, overall population, population over 75 years, median income, number of physicians and GP per inhabitant.ResultsIn all, 21,821 patients included from 2003 to 2015, 16,980 (78 %) men, 4783 (22 %) women, mean age 62 ± 14 years. MG's call decreased from 20 % (2003) to 8 % (2015) (P < 0.0001 Cochran-Armitage). Management time was significantly shorter: 76 vs. 173 min in case of a direct call to the SAMU (P < 0.0001 Wilcoxon). The MG call increased significantly with the rate of doctors (R2 = 0.5; P = 0.04) and GP (R2 = 0.6; P = 0.03) per million inhabitants, but was independent of other criteria.ConclusionThe direct call to the SAMU reduced the time of care of STEMI patients. Initial GP contact must be further reduced to favor access to the “lucky way”