L’expertise

De longue date, les reproches essentiels formulés à propos de la procédure d'expertise judiciaire, actuellement organisée par les articles 962 à 991 du Code judiciaire, se sont focalisés autour de deux grands thèmes : - le coût excessif de ce genre de procédure ; - la durée anormalement longue de son déroulement. Le Code judiciaire a voulu remédier à ces griefs, tout en admettant la nécessité de recourir à ce mode de preuve lorsque l'enjeu du litige dépasse d'un point de vue technique les compétences de nos Cours et Tribunaux. Les trente articles du Code judiciaire relatifs à l'expertise sont cependant source de nombreuses dérives, susceptibles de se produire à tous les stades de la procédure. Il a dès lors paru indispensable de les dénoncer, mais également d'envisager les palliatifs et/ou remèdes dont les acteurs (magistrats, avocats, experts,...) disposent. La qualité et l'expérience en la matière des intervenants aux journées d'étude organisées témoignent à suffisance de l'intérêt qu'ils ont suscité

Les conflits collectifs en droit du travail : Solutions négociées ou interventions judiciaires

Le règlement pacifique des conflits collectifs, qui constitue l'une des caractéristiques les plus remarquables du système juridique belge en matière de relations de travail, est-il remis en question ? D'aucuns ont pu certainement le craindre à la suite des nombreux conflits collectifs récents pour lesquels les protagonistes n'ont cessé de solliciter l'intervention du pouvoir judiciaire en vue de mettre un terme aux différends qui les opposaient. Le présent ouvrage reprend les contributions juridiques qui ont été présentées à l'occasion d'une journée d'études organisée par la Faculté de droit des Facultés universitaires Saint-Louis le 10 juin 1988 et consacrée à cette évolution récente des modes de règlement des conflits collectifs du travail. Il est apparu également intéressant et utile, pour la bonne compréhension des débats qu'un tel thème peut soulever, de publier les réflexions émises par les participants à la table ronde constituée à l'occasion de cette journée

Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery

In thyroid surgery, intra-operative neuromonitoring of the recurrent laryngeal nerve (RLN) and vagal nerve (VN) are performed as an adjunct to the gold standard of optical visualisation of the RLN, to avoid injury of the RLN, and subsequently paralysis of the vocal cords. Intermittent RLN neuromonitoring diminished the temporary RLN palsy rate, but continuous neuromonitoring could have to potential of avoiding any damage. Since no study evaluated continuous vagal stimulation before, the objective of this study was to evaluate continuous neuromonitoring in a clinical setting, to assess its' value in predicting vocal cord injury. A single centre prospective study was performed from September 2010 till February 2012, including 100 consecutive thyroidectomies with continuous VN stimulation using an S-shaped electrode. In this study, 100 thyroidectomies (80 total thyroidectomies and 20 hemi-thyroidectomies) were analysed. On 180 nerves at risk (NAR), there were four RLN palsies (2.2 %), of which only one definitive. In the cases with temporary palsies, an intra-operative diminution of the amplitude occurred, recovering partially with release of traction. Loss of signal was seen in all four cases, with an abrupt loss of signal in the definitive one. The RLN function remained intact in the other 176 NAR. Continuous neuromonitoring of the VN is accurate and precise in predicting vocal cord palsy. It is of tremendous importance that the vagal electrode is a-traumatic and gives a stable signal. The exact parameters regarding "warning signs" have yet to be determined, but amplitude changes seem to play a major role

Effects of Aroclor 1254 on oxidative stress in developing Xenopus laevis tadpoles.

Over the last decades, amphibians decline has been reported worldwide. Exposure to polychlorinated biphenyls (PCBs) is one of the possible causes in addition to climate changes, UV-radiation or habitat destruction. In the present study, we tested the hypothesis that PCBs could induce oxidative stress in young tadpoles. Developing Xenopus laevis were exposed from 2- to 5-d postfertilization (pf) to 0.1 or 1 mg/l of Aroclor 1254. Lipid peroxidation and antioxidant systems (SOD, CAT, GST, GPx, GR activities and t-GSH level) were investigated in whole organisms. Exposure to both concentrations did not impact on the survival and development whereas the average body weight decreased. Exposure to 1 mg/l of Aroclor 1254 induced a significant (p<0.05) increase of GST activity when compared to controls 0 and DMSO. The other antioxidant enzymes and LPO evaluation remained unchanged. Our results demonstrate that exposure of X. laevis tadpoles to environmental concentrations of Aroclor 1254 interfere with normal growth. They also highlight that very young X. laevis tadpoles express antioxidant systems

Surgery for gastrointestinal endometriosis : indications and results

Background: Although gastrointestinal endometriosis is an uncommon and often unexpected finding, the best treatment requires removal of all endometriotic lesions. The purpose of our study was to report our experience with the diagnosis and treatment of bowel endometriosis. Material and Methods : From January 1997 to January 2004, 13 patients (mean 35.7y; range 21-55y) were operated for bowel endometriosis. We noted : age, history of endometriosis, previous pregnancies, preoperative investigations and symptoms, operative procedure and intraoperative findings. Follow-up varied between one month postoperative examination and seven years. Results : Presenting symptoms of the cases were : acute appendicitis (3), dysmenorrhoea (7), constipation (6), pelvic pain (2), rectal bleeding (3) and dyspareunia (2). Operative management was performed in accordance with the anatomical distribution. Seven patients had a history of previous operations and multifocal involvement was present in 61.5% of cases. At a median follow-up of 12.2 months, 83.3% had complete relief of their initial complaints, with only one reoperation needed. The pregnancy rate after surgery was 66.6%. Preoperative tests were : ultrasound for ovarian endometriomas, coloscopy, barium enema, vaginal palpation for detecting rectovaginal involvement, MRI and CT scan. These tests predicted the extension of endometriotic process correctly in 50% of the cases. Conclusions : Endometriosis of the sigmoid and rectum is rare but can give rise to severe gastrointestinal and pelvic symptoms. Preoperative investigations are not infallible in predicting the extent of the disease, sometimes placing the surgeon before a dilemma, because it involves mostly young women in the reproductive phase of life. The colorectal surgeon, therefore, should seek the advice of an experienced gynaecologist and vice versa. Removal of all endometriotic lesions is mandatory for obtaining an optimal relief of symptoms

Comparison of volume and pressure controlled ventilation during laparoscopic bariatric surgery

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Comparison of the harmonic focus and the thunderbeat for open thyroidectomy

An effective method for controlling haemostasis during open thyroidectomy procedures is crucial because of the high risks of haemorrhage and neck haematoma. This study aimed to demonstrate the efficacy of the integrated ultrasonic/bipolar Thunderbeat (TM) for this procedure. This retrospective non-inferiority study compared the Thunderbeat (TM) and the ultrasonic Harmonic FocusA (R) devices in 761 consecutive patients receiving a partial or total open thyroidectomy (with or without neck dissection). The main outcomes were duration of surgery, blood loss, and length of hospitalisation. Secondary outcomes were occurrence of hypocalcaemia, recurrent nerve paralysis, or other post-operative complications. A non-inferiority logistic regression approach was used to evaluate primary outcomes, adjusting for age, gender, body mass index, type of surgery, anaesthesiology score, and indication (benign or malign). The data demonstrated that the Thunderbeat was non-inferior to the Focus in terms of duration of surgery, blood loss, and length of hospital stay. Furthermore, subgroup analyses showed non-inferiority of the Thunderbeat for partial thyroidectomy (all three outcomes), total thyroidectomy (duration of surgery and length of hospitalisation), and total thyroidectomy with neck dissection (length of hospitalisation). In terms of recurrent nerve paralysis and post-operative complications, the Thunderbeat performed at least as well as the Focus; however, no conclusions could be drawn regarding the occurrence of post-operative hypocalcaemia. In a cohort of patients that underwent partial or total thyroidectomy, the Thunderbeat appeared to be at least as good as the Harmonic Focus

Intraoperative high-dose-rate Brachytherapy (IBT) for locally unresectable intraabdominal malignancy

Purpose : Intraoperative high-dose-rate brachytherapy (IBT) has been successfully used in locally advanced unresectable intraabdominal malignancy. We retrospectively evaluated the safety, feasibility, and general outcome of IBT following cytoreductive surgery. Patients and methods : After radical resection, the target area to be treated by IBT was determined jointly by the surgeon and the radiation oncologist. A silicon template was used to position parallel hollow catheters spaced 1 cm apart against the area of interest. IBT doses were prescribed at I cm depth from the template surface and calculated using standard plans. Radiation was administered in a dedicated shielded room. Results : Between August 2001 and February 2006, 10 patients (colorectal cancer n = 6, cervix cancer n = 1, extramedullar plasmocytoma n = 1, liposarcoma n = I and sacrococcygeal teratocarcinoma n = 1) were treated. The mean delivered IBT dose was 8 Gy (range 7.5-20). No postoperative mortality was seen, while major complications developed in one (10%) patient with a rectovaginal fistula and intraabdominal abscess. Five of the six colorectal cancer patients developed local recurrence while 3 also developed distant metastases. The mean disease-free and overall survival in this group was 8.5 months (range 4-15) and 25.5 months (range 10-48) respectively. Palliation of symptoms was observed in 89% of cases. Conclusion : IBT combined with debulking surgery is feasible and can be safely performed. While cure is rarely achieved, IBT offers the potential to prolong local control and survival in locally unresectable intraabdominal cancer. Therefore, IBT can be considered as a valuable adjuvant in the therapeutic and palliative armamentarium in these selected patients