Traumatismes fermés du pancréas chez l'enfant : approche diagnostique et traitement non-opératoire

Moins de 0,5% à 12% des enfants avec un traumatisme abdominal développent une atteinte pancréatique.(1-5) Ces lésions pancréatiques résultent majoritairement de traumatismes abdominaux fermés.(1) Du fait de la nature corrosive des sécrétions pancréatiques, la guérison du pancréas est difficile. Il est donc important de poser rapidement le bon diagnostic et d'instaurer une prise en charge efficace. Cependant, diagnostiquer une atteinte pancréatique n'est pas toujours évident(6-8) au vu de la faible incidence de ces traumas et de la sémiologie non spécifique associée. La prise en charge thérapeutique reste actuellement controversée, surtout dans les cas les plus graves : faut-il opérer ou opter pour une prise en charge non-opératoire?(1,9) Le Centre Hospitalier Universitaire Vaudois (CHUV) est l'un des centres de référence suisses de chirurgie pédiatrique. Depuis la fin des années 1990, tous les cas de traumatismes pancréatiques pédiatriques, sauf un, y ont été pris en charge de manière non- opératoire. Cette prise en charge conservatrice a été effectuée indépendamment du degré de sévérité du trauma. Le but de cette étude est donc de rapporter et d'analyser les modalités de l'approche diagnostique et de traitement non-opératoire, qui sont appliquées dans cet hôpital depuis 1999

"Mieux vaut prévenir que guérir": les infections nosocomiales en chirurgie : revue de la littérature

La prévention des infections nosocomiales est très importante, impliquant la res-ponsabilité de l’ensemble du personnel soignant. C’est pourquoi, les objectifs de cette re-vue de la littérature sont de déterminer la pertinence des mesures médico-infirmières en chirurgie générale et de discriminer la méthode la plus efficace pour prévenir les infections nosocomiales. Les études analysées, publiées entre 2011 et 2016, concernent la chirurgie géné-rale, chez des patients ou des volontaires sans maladie immunodépressive, en période pré ou peropératoire. Les études portant sur la chirurgie ophtalmologique, oto-rhino-laryngologique (ORL) et sur la résection endoscopique transurétrale de la prostate (REP) sont exclues. Les recherches ont été effectuées de novembre 2016 à janvier 2017 sur CINAHL, Pubmed, Elsevier Science Direct et BDSP avec des mots-clés anglais assem-blés grâce à l’opérateur boléen « AND ». Les principaux résultats mettent en évidence que l’utilisation d’une tondeuse avec assistance d’aspiration de poils comporte moins de contamination microbienne qu’une tondeuse simple ; qu’il n’y a pas moins d’infections chez les personnes dépilées avec une tondeuse simple que chez les personnes non dépilées ; qu’une pause d’une ou de deux minutes entre l’application et le rinçage du gluconate de Chlorhexidine et que l’utilisation d’un flacon de 118 ml augmentent son efficacité. En conclusion, cette revue de la littéra-ture met en avant des pistes d’amélioration pour la pratique permettant d’augmenter la qualité des soins

Recent developments in the use of isotope ratio mass spectrometry in sports drug testing

According to the annual report of the World Anti-Doping Agency, steroids are the most frequently detected class of doping agents. Detecting the misuse of endogenously occurring steroids, i.e. steroids such as testosterone that are produced naturally by humans, is one of the most challenging issues in doping control analysis. The established thresholds for urinary concentrations or concentration ratios such as the testosterone/epitestosterone quotient are sometimes inconclusive owing to the large biological variation in these parameters. For more than 15years, doping control laboratories focused on the carbon isotope ratios of endogenous steroids to distinguish between naturally elevated steroid profile parameters and illicit administration of steroids. A variety of different methods has been developed throughout the last decade and the number of different steroids under investigation by isotope ratio mass spectrometry has recently grown considerably. Besides norandrosterone, boldenone was found to occur endogenously in rare cases and the misuse of corticosteroids or epitestosterone can now be detected with the aid of carbon isotope ratios as well. In addition, steroids excreted as sulfoconjugates were investigated, and the first results regarding hydrogen isotope ratios recently became available. All of these will be presented in detail within this review together with some considerations on validation issues and on identification of parameters influencing steroidal isotope ratios in urin

A new multimodal paradigm for biomarkers longitudinal monitoring: a clinical application to women steroid profiles in urine and blood.

Most current state-of-the-art strategies to generate individual adaptive reference ranges are designed to monitor one clinical parameter at a time. An innovative methodology is proposed for the simultaneous longitudinal monitoring of multiple biomarkers. The estimation of individual thresholds is performed by applying a Bayesian modeling strategy to a multivariate score integrating several biomarkers (compound concentration and/or ratio). This multimodal monitoring was applied to data from a clinical study involving 14 female volunteers with normal menstrual cycles receiving testosterone via transdermal route, as to test its ability to detect testosterone administration. The study samples consisted of urine and blood collected during 4 weeks of a control phase and 4 weeks with a daily testosterone gel application. Integrating multiple biomarkers improved the detection of testosterone gel administration with substantially higher sensitivity compared with the distinct follow-up of each biomarker, when applied to selected urine and serum steroid biomarkers, as well as the combination of both. Among the 175 known positive samples, 38% were identified by the multimodal approach using urine biomarkers, 79% using serum biomarkers and 83% by combining biomarkers from both biological matrices, whereas 10%, 67% and 64% were respectively detected using standard unimodal monitoring. The detection of abnormal patterns can be improved using multimodal approaches. The combination of urine and serum biomarkers reduced the overall number of false-negatives, thus evidencing promising complementarity between urine and blood sampling for doping control, as highlighted in the case of the use of transdermal testosterone preparations. The generation in a multimodal setting of adaptive and personalized reference ranges opens up new opportunities in clinical and anti-doping profiling. The integration of multiple parameters in a longitudinal monitoring is expected to provide a more complete evaluation of individual profiles generating actionable intelligence to further guide sample collection, analysis protocols and decision-making in clinics and anti-doping

Bayesian detection of abnormal hematological values to introduce a no-start rule for heterogeneous populations of athletes.

Sports authorities exclude athletes with abnormal levels of blood parameters. Here, the consideration of longitudinal blood profiles together with heterogeneous factors such as ethnicity and age produces a model with enhanced sensitivity to detect blood doping. Sports disciplines with heterogeneous populations now have a general method to introduce the no-start rule

Urinary Analysis of Four Testosterone Metabolites and Pregnanediol by Gas Chromatography-Combustion-Isotope Ratio Mass Spectrometry after Oral Administrations of Testosterone

The most frequently used method to demonstrate testosterone abuse is the determination of the testosterone and epitestosterone concentration ratio (T/E ratio) in urine. Nevertheless, it is known that factors other than testosterone administration may increase the T/E ratio. In the last years, the determination of the carbon isotope ratio has proven to be the most promising method to help discriminate between naturally elevated T/E ratios and those reflecting T use. In this paper, an excretion study following oral administration of 40 mg testosterone undecanoate initially and 13 h later is presented. Four testosterone metabolites (androsterone, etiocholanolone, 5α-androstanediol, and 5β-androstanediol) together with an endogenous reference (5β-pregnanediol) were extracted from the urines and the δ13C/12C ratio of each compound was analyzed by gas chromatography-combustion-isotope ratio mass spectrometry. The results show similar maximum δ13C-value variations (parts per thousand difference of δ13C/12C ratio from the isotope ratio standard) for the T metabolites and concomitant changes of the T/E ratios after administration of the first and the second dose of T. Whereas the T/E ratios as well as the androsterone, etiocholanolone and 5α-androstanediol δ13C-values returned to the baseline 15 h after the second T administration, a decrease of the 5β-androstanediol δ-values could be detected for over 40 h. This suggests that measurements of 5β-androstanediol δ-values allow the detection of a testosterone ingestion over a longer post-administration period than other T metabolites δ13C-values or than the usual T/E ratio approac

Detection of Exogenous GHB in Blood by Gas Chromatography-Combustion-Isotope Ratio Mass Spectrometry: Implications in Postmortem Toxicology

Because GHB (γ-hydroxybutyrate) is present in both blood and urine of the general population, toxicologists must be able to discriminate between endogenous levels and a concentration resulting from exposure. In this paper, we propose a procedure for the detection of exogenous GHB in blood by gas chromatography-combustion-isotope ratio mass spectrometry (GC-C-IRMS). Following liquid-liquid and solid-phase extractions, GHB is derivatized to GHB di-TMS before analysis by GC-C-IRMS. Significant differences in the carbon isotopic ratio (Δδ13C-values > 13.5‰) were found between endogenous and synthetic GHB. Indeed, for postmortem blood samples with different GHB concentrations (range: 13.8-86.3 mg/L), we have obtained GHB δ13C-values ranging from −20.6 to −24.7‰, whereas δ13C-values for the GHB from police seizure were in the range −38.2 to −50.2‰. In contrast to the use of cut-off concentrations for positive postmortem blood GHB concentrations, this method should provide an unambiguous indication of the drug origi