Actual knowledge of systemic inflammation reaction during cardiopulmonary bypass

Systemic inflammation response is a complex physiopathological host response following aggression. This phenomenon is well described during cardiac surgery under cardiopulmonary bypass but also in the context of off-pump cardiac surhery. The goal of this article is to review the different mechanisms involved in the systemic inflammation response, abusively called "systemic inflammatory response syndrome". The article will describe the different component of this response with a clear definition of different pathways found in this process. The possible relation between systemic inflammation and postoperative outcome will be described. The different therapeutic and prophylactic options evaluated to decrease the systemic inflammation reaction will be summarized. © 2012 Bentham Science Publishers.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Rôles de l’inflammation et de l’apoptose dans la perturbation du dialogue cœur-poumon : applications particulières à la mort cérébrale

Brain death is associated with heart dysfunction and acute lung injury. We investigated the involvement of inflammation and apoptosis in three animal models of right ventricle dysfunction associated with pulmonary hypertension. We developed a new brain-death model reproducing the conditions of a brain hemorrhage. In this model, we studied the pathobiological and pathophysiological mechanisms involved in these dysfunctions and using methylprednisolone pretreatment. Brain death is associated with right ventricular dysfunction and neurogenic pulmonary edema with a strong link between these dysfunctions and activation of inflammatory and apoptotic process. The functional entity “right ventricle - lung” seems particularly affected by brain death. Corticosteroids prevent these disturbances by a vasodilatory effect and partial control of inflammation and apoptosis.(MED - Sciences médicales) -- UCL, 201

Exploration des défis d’IT outsourcing au Maroc : Vers la conception d’un contrat résilient

Modern companies are called upon to keep pace with the rapid development and change taking place in the field of information technology. Indeed, to fully play its roles, the company is called upon to hire a competent team for its IT function, which masters both the technical and the managerial aspects. However, having a competent IT team is not always easy. Faced with this situation, companies often opt for IT outsourcing practices, entrusting all or part of their IT management to an external, competent and professional company. This article aims to explore the challenges faced by IT service providers (IT suppliers) and enterprises (customers) in managing an IT outsourcing relationship. To this end, we conducted a qualitative case study. Data were collected via semi-structured interviews and analyzed using thematic content analysis. The results highlight a series of challenges that both parties must overcome when agreeing to sign an IT outsourcing contracts. These challenges relate in particular to the agreement of service levels, the contract duration, the type of contract, the decision to invest or not to invest in IT, the cost of the contract, and finally the contractual relationship and risk management linked to the IT outsourcing contracts. This article, from a supplier-oriented perspective, contributes to an understanding of the constraints and stakes of an IT outsourcing contractual relationship, and presents an explanation of the challenges that lead to a successful IT outsourcing contract.   Keywords: IT outsourcing, IT externalization, IT outsourcing challenges, IT contract, IT service provider. Classification JEL : M15, O32, Q55. Paper type: Empirical ResearchLes entreprises modernes sont appelées à suivre le développement et le changement rapide que connaît le domaine des technologies de l’information. En effet, pour jouer pleinement ses rôles, l’entreprise est appelée à engager une équipe compétente pour sa fonction IT, qui maîtrise à la fois le volet technique et le volet managérial. Or, se doter d’une équipe IT compétente n’est pas toujours évident. Devant cette situation, les entreprises optent souvent pour des pratiques d’IT outsourcing pour confier une partie ou la totalité de la gestion informatique à une société externe, compétente et professionnelle. Cet article vise à explorer les défis que rencontrent les sociétés de fourniture de services IT (fournisseurs IT) et les entreprises clientes dans la gestion d’une relation d’externalisation IT. Pour ce faire, nous avons mené une étude qualitative par étude de cas. Les données ont été collectées via l’entretien semi-directif et sont analysées par une analyse du contenu thématique. Les résultats mettent l’accent sur un ensemble de défis que les deux parties doivent enlever en acceptant de signer un contrat d’IT outsourcing. Ces défis concernent spécialement l’accord des niveaux de services, la durée de contrat, le type de contrat, la décision d’investir ou de ne pas investir dans l’IT, le coût du contrat, et finalement la relation contractuelle et la gestion des risques liés au contrat d’IT outsourcing. Cet article, à travers une perspective orientée fournisseur, contribue à la compréhension des contraintes et des enjeux d’une relation contractuelle de sous-traitance informatique et présente une explication des défis qui mènent vers la réussite d’un contrat d’IT outsourcing.   Mots clés : IT outsourcing, Externalisation informatique, Défis d’IT outsourcing, contrat IT, Prestataire de services IT. JEL Classification : M15, O32, Q55. Type du papier : Recherche empiriqu

Traitement chirurgical d’un pseudo-anévrysme post-traumatique de l’artère subclavière droite

Un traumatisme de l'artère subclavière proximale droite est peu fréquent et tend à être associé à la formation d'un pseudoanévrysme. Actuellement, le traitement de choix consiste en une exclusion du pseudo-anévrysme par un stent placé par voie endovasculaire. La chirurgie ouverte est un défi chirurgical en raison de la position anatomique de l’artère subclavière et est associée à un taux élevé de morbidité et de mortalité. Nous présentons le cas d'un patient de 71 ans ayant un pseudoanévrysme de l'artère subclavière proximale droite 11 ans après un accident de voiture. L’objectif est de démontrer que la pathologie a été traitée avec succès par chirurgie vasculaire après échecs de plusieurs procédures endovasculaires. Un pontage aorto-carotido-subclavier droit a été réalisé par abord combiné associant une sternotomie complète à une cervicotomie droite. Le suivi à 6 semaines confirme l’exclusion du pseudo-anévrysme et la perméabilité des troncs revascularisés

A rare case of aortic endograft infection by Francisella tularensis: A case report.

INTRODUCTION AND IMPORTANCE: endovascular repair is an alternative to open repair for abdominal aortic aneurysms (AAA), which lowers morbidity and mortality but may presents infectious complications. Endograft infection is a rare but serious life-threatening condition with a mortality rate up to 50 %. We reported a case of aortic endograft infection by Francisella tularensis, rare and highly virulent gram-negative coccobacillus known for use in bioterrorism. CASE PRESENTATION: A 79-year-old man presented with asthenia, weight loss, night sweats and one episode of fever. In 2007, he underwent aorto-bi-iliac endograft repair for AAA without any complication. The diagnostic workup showed some signs of inflammation, but negative blood cultures and no sign of infection on CT scan. The combination of positron emission tomography (PET) and white blood cell (WBC) scintigraphy led to the diagnosis of aortic endograft infection. The management was antimicrobial therapy and surgery. Perioperative analysis shows the presence of Francisella Tularensis. DISCUSSION AND CONCLUSIONS: Aortic endograft infection is a serious complication with a high mortality rate. Its diagnosis may be difficult, but the combination of WBC scintigraphy and PET scan may improve identification of the infection, even if blood cultures and CT scan are negative. The gold standard treatment is removal of the endograft, debridement, and in situ reconstruction along with antibacterial therapy

Giant true aneurysm of superficial femoral artery in patient with multiple atherosclerotic aneurysms: A case report.

True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms. We report the case of a 84-year-old patient presenting a giant degenerative ruptured aneurysm of the superficial femoral artery. The patient underwent successful aneurysm resection and bypass grafting, with a satisfying long-term follow-up and patency of the graft. The patient was also operated one year before, for a ruptured aneurysm of the abdominal aorta. This case report is rare, because we described a case of patient with multiple atherosclerotic aneurysms, who present, for the second time, a life threating ruptured aneurysm. In this report, we see extreme and rapid evolution of SFA Aneurysm before being symptomatic. Degenerative aneurysms of the lower extremity most commonly involve the popliteal artery, while they are rarely detected in the femoral region (Leon et al., 2008). In this region, aneurysms most frequently involve the common femoral artery (CFA), whereas true aneurysms of the superficial femoral artery (SFA) represent only 15% to 25% of femoral arterial aneurysms [1-5]. Degenerative aneurysms of the SFA display peculiar characteristics (in terms of clinical onset, diagnostic timing, and clinical behavior) so that they differ from other peripheral aneurysms. Because the relative rarity of this location, our case report can be useful to participate to increase the number of reported cases, and define the therapeutic approach for this rare location

Surgical Resection of Painless Carotid Body Tumour without Preoperative Embolization: A Case Report and Review of Literature

Paragangliomas are rare tumors representing a therapeutic challenge. We present a case report of surgical resection of carotid body tumor without preoperative embolization. Our therapeutic attitude is based on controversial benefits of the embolization for those tumors. The major indication for the preoperative embolization is to reduce intraoperative blood loss, but this benefit is not demonstrated. Also, because the relative rarity of this tumor, the confounding factors relative to the surgeon and radiologist experience, no randomized trial can be performed. So, our case report can be useful to participate to increase the number of reported cases, and define the therapeutic approach for this rare tumor

Etude de la signalisation de l’hème oxygénase dans un modèle de défaillance ventriculaire droite sur hypertension pulmonaire sur shunt systémo-pulmonaire -- Médecine - Candidat spécialiste

info:eu-repo/semantics/nonPublishe

Successful Pulmonary and Aortic Embolectomies Under Tepid Circulatory Arrest: A Case Report

Pulmonary embolism is a major complication of Deep Vein Thrombosis (DVT). In severe cases, it causes an increase in pulmonary arterial pressure and right ventricular post-charge that results in right-sided heart failure. The enlargement of the right-sided cavities facilitates the opening of right-to-left shunts, thereby allowing the passage of thrombi into the systemic circulation, i.e., paradoxical embolism