Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 31
Filter
2.
Br J Neurosurg ; 34(4): 370-380, 2020 Aug.
Article in English | MEDLINE | ID: mdl-31771363

ABSTRACT

Background: Optimal surgical management of spinal injuries as part of life-threatening multiple traumas remains challenging. We provide insights into the surgical management of spinal injuries in polytrauma patients. Methods: All patients from our polytrauma care network who both met at least one positive Vittel criteria and an injury severity score (ISS) >15 at admission and who underwent surgery for a spinal injury were included retrospectively. Demographic data, clinical data demonstrating the severity of the trauma and imaging defining the spinal and extraspinal number and types of injuries were collected.Results: Between January 2012 and December 2016, 302 (22.2%) patients suffered from spinal injury (143 total injuries) and 83 (6.1%) met the inclusion criteria. Mean ISS was 36.2 (16-75). Only 48 (33.6%) injuries led to neurological impairment involving the thoracic (n = 23, 16.1%) and lower cervical (n = 15, 10.5%) spine. The most frequent association of injuries involved the thoracic spine (n = 42). 106 spinal surgeries were performed. The 3-month mortality rate was 2.4%.Conclusions: We present data collected on admission and in the early postoperative period referring to injury severity, the priority of injuries, and development of multi-organ failure. We revealed trends to guide the surgical support of spinal lesions in polytrauma patients.


Subject(s)
Multiple Trauma , Spinal Injuries , Humans , Injury Severity Score , Multiple Trauma/surgery , Postoperative Period , Retrospective Studies , Spinal Injuries/surgery
3.
Med Sante Trop ; 29(2): 121-126, 2019 May 01.
Article in English | MEDLINE | ID: mdl-31010804

ABSTRACT

INTRODUCTION: Use of chronic intermittent hemodialysis is recent in Chad, where it remains underdeveloped. Vascular access is most commonly by catheter. The objective of our study was to demonstrate the feasibility of arteriovenous fistula (AVF) surgery for hemodialysis during deployments as part of the medical civic action program (MEDCAP). METHODS: We prospectively included all patients admitted for AVF creation at Camp Kossei forward surgical unit in N'Djamena (Chad) between December 2016 and February 2017. Surgery was performed by an experienced vascular surgeon. The data collected included age, sex, cause of kidney failure, type of anesthesia, AVF location, and the duration of the intervention and hospitalization. Patients were examined one month after the procedure to evaluate the functionality, morbidity, and mortality of the AVF. RESULTS: We performed 17 AVF in 3 months. Male to female ratio was 3. High blood pressure was the main cause of chronic kidney failure (55%). All interventions were conducted under locoregional anesthesia. Overall, 35% of fistulae were radiocephalic, 41% brachiocephalic, and 24% brachiobasilic. The mean duration of intervention was 58 minutes and that of hospitalization one day. No deaths occurred. Global morbidity, including non-functioning AVF, was 25%. CONCLUSION: Our study showed that AVF surgery is feasible during deployment, especially in Chad, and meets the needs of the local healthcare facilities. It should be developed and taught to local surgeons.


Subject(s)
Arteriovenous Shunt, Surgical , Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Adult , Aged , Chad , Feasibility Studies , Female , France , General Surgery , Humans , International Cooperation , Male , Middle Aged , Military Medicine , Prospective Studies , Young Adult
5.
J Visc Surg ; 2017 Nov 24.
Article in English | MEDLINE | ID: mdl-29239852

ABSTRACT

Management of patients with penetrating trauma of the abdomen, pelvis and their surrounding compartments as well as vascular injuries depends on the patient's hemodynamic status. Multiple associated lesions are the rule. Their severity is directly correlated with initial bleeding, the risk of secondary sepsis, and lastly to sequelae. In patients who are hemodynamically unstable, the goal of management is to rapidly obtain hemostasis. This mandates initial laparotomy for abdominal wounds, extra-peritoneal packing (EPP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) in the emergency room for pelvic wounds, insertion of temporary vascular shunts (TVS) for proximal limb injuries, ligation for distal vascular injuries, and control of exteriorized extremity bleeding with a tourniquet, compressive or hemostatic dressings for bleeding at the junction or borderline between two compartments, as appropriate. Once hemodynamic stability is achieved, preoperative imaging allow more precise diagnosis, particularly for retroperitoneal or thoraco-abdominal injuries that are difficult to explore surgically. The surgical incisions need to be large, in principle, and enlarged as needed, allowing application of damage control principles.

7.
J Visc Surg ; 154 Suppl 1: S31-S33, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29050946

ABSTRACT

Damage control for thoracic trauma combines definitive and temporary surgical gestures specifically adapted to the lesions present. A systematic assessment of all injuries to prioritize the specific lesions and their treatments constitutes the first operative stage. Packing and temporary closure have a place in the care of chest injuries.


Subject(s)
Thoracic Injuries/therapy , Combined Modality Therapy , Drainage/methods , Hemostatic Techniques , Humans , Resuscitation/methods , Thoracostomy , Thoracotomy , Wound Closure Techniques
8.
J Visc Surg ; 154 Suppl 1: S35-S41, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28941568

ABSTRACT

Resuscitation thoracotomy is a rarely performed procedure whose use, in France, remains marginal. It has five specific goals that correspond point-by-point to the causes of traumatic cardiac arrest: decompression of pericardial tamponade, control of cardiac hemorrhage, performance of internal cardiac massage, cross-clamping of the descending thoracic aorta, and control of lung injuries and other intra-thoracic hemorrhage. This approach is part of an overall Damage Control strategy, with a targeted operating time of less than 60minutes. It is indicated for patients with cardiac arrest after penetrating thoracic trauma if the duration of cardio-pulmonary ressuscitation (CPR) is <15minutes, or <10minutes in case of closed trauma, and for patients with refractory shock with systolic blood pressure <65mm Hg. The overall survival rate is 12% with a 12% incidence of neurological sequelae. Survival in case of penetrating trauma is 10%, but as high as 20% in case of stab wounds, and only 6% in case of closed trauma. As long as the above-mentioned indications are observed, resuscitation thoracotomy is fully justified in the event of an afflux of injured victims of terrorist attacks.


Subject(s)
Heart Arrest/surgery , Heart Injuries/surgery , Hemostatic Techniques , Resuscitation/methods , Thoracic Injuries/surgery , Thoracotomy , Heart Arrest/etiology , Heart Injuries/complications , Humans , Thoracic Injuries/complications
9.
J Visc Surg ; 154(3): 167-174, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27856172

ABSTRACT

INTRODUCTION: In France, non-operative management (NOM) is not the widely accepted treatment for penetrating wounds. The aim of our study was to evaluate the feasibility of NOM for the treatment of penetrating abdominal traumas at 3 hospitals in the Southeast of France. METHODOLOGY: Our study was multicentric and retroprospective from January, 2010 to September, 2013. Patients presenting with a penetrating abdominal stab wound (SW) or gunshot wound (GSW) were included in the study. Those with signs of acute abdomen or hemodynamic instability had immediate surgery. Patients who were hemodynamically stable had a CT scan with contrast. If no intra-abdominal injury requiring surgery was evident, patients were observed. Criteria evaluated were failed NOM and its morbidity, rate of non-therapeutic procedures (NTP) and their morbidity, length of hospital stay and cost analysis. RESULTS: One hundred patients were included in the study. One patient died at admission. Twenty-seven were selected for NOM (20 SW and 7 GSW). Morbidity rate was 18%. Failure rate was 7.4% (2 patients) and there were no mortality. Seventy-two patients required operation of which 22 were NTP. In this sub-group, the morbidity rate was 9%. There were no mortality. Median length of hospital stay was 4 days for the NOM group and 5.5 days for group requiring surgery. Cost analysis showed an economic advantage to NOM. CONCLUSION: Implementation of NOM of penetrating trauma is feasible and safe in France. Indications may be extended even for some GSW. Clinical criteria are clearly defined but CT scan criteria should be better described to improve patient selection. NOM reduced costs and length of hospital stay.


Subject(s)
Abdominal Injuries/therapy , Length of Stay , Patient Selection , Wounds, Penetrating/therapy , Abdominal Injuries/diagnosis , Abdominal Injuries/economics , Abdominal Injuries/epidemiology , Adolescent , Adult , Aged , Costs and Cost Analysis , Feasibility Studies , Female , France/epidemiology , Humans , Incidence , Injury Severity Score , Male , Middle Aged , Practice Guidelines as Topic , Prospective Studies , Retrospective Studies , Risk Factors , Trauma Centers , Treatment Outcome , Wounds, Gunshot/therapy , Wounds, Penetrating/diagnosis , Wounds, Penetrating/economics , Wounds, Penetrating/epidemiology , Wounds, Stab/therapy
10.
J Visc Surg ; 153(4 Suppl): 3-12, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27260640

ABSTRACT

Severe trauma patients should be received at the hospital by a multidisciplinary team directed by a "trauma leader" and all institutions capable of receiving such patients should be well organized. As soon as the patient is accepted for care, the entire team should be prepared so that there is no interruption in the pre-hospital chain of care. All caregivers should thoroughly understand the pre-established protocols of diagnostic and therapeutic strategies to allow optimal management of unstable trauma victims in whom hemostasis must be obtained as soon as possible to decrease the morbid consequences of post-hemorrhagic shock. In patients with acute respiratory, circulatory or neurologic distress, several surgical procedures must be performed without delay by whichever surgeon is on call. Our goal is to describe these salvage procedures including invasive approaches to the upper respiratory tract, decompressive thoracostomy, hemostatic or resuscitative thoracotomy, hemostatic laparotomy, preperitoneal pelvic packing, external pelvic fixation by a pelvi-clamp, decompressive craniotomy. All of these procedures can be performed by all practitioners but they require polyvalent skills and training beforehand.


Subject(s)
Hospitalization , Patient Care Team , Wounds and Injuries/surgery , Craniotomy , Decision Making , Emergency Service, Hospital , Hemostasis, Surgical , Humans , Laparotomy , Patient Admission , Pelvis/injuries , Respiratory Distress Syndrome/therapy , Shock/therapy , Thoracic Injuries/surgery , Thoracotomy , Tracheotomy , Trauma Centers/organization & administration
11.
J R Army Med Corps ; 162(5): 343-347, 2016 Oct.
Article in English | MEDLINE | ID: mdl-26462741

ABSTRACT

INTRODUCTION: The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)-called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)-has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed. METHODS: Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops. RESULTS: The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects. CONCLUSION: The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties.


Subject(s)
Curriculum , Education, Medical, Continuing/methods , General Surgery/education , Military Medicine/education , Orthopedics/education , Traumatology/education , Clinical Competence , France , Humans
12.
Rev Pneumol Clin ; 70(3): 127-32, 2014 Jun.
Article in French | MEDLINE | ID: mdl-24210156

ABSTRACT

INTRODUCTION: Catamenial pneumothorax (PNO) is a real clinical occurrence. Several cases are reported in the literature as a spontaneous PNO occurring during the catamenial period among women in their thirties. There is no consensus about management and the recurrence rate is very high whatever the initial treatment. PATIENTS AND METHODS: Among 310 cases of spontaneous PNO operated in our institution in 10 years, we identified five cases of catamenial PNO. A retrospective study of these cases was used to study the initial operating data, including the existence of intrathoracic lesions and the choice of technique of pleurodesis. Patient follow-up was clinically and radiologically. Adjuvant hormonal therapies, recurrence of PNO and treatment modalities have been studied. RESULTS: These five patients of average age 37.6 years (37,38) who had 2.6 (2.3) episodes of right catamenial PNO before hospitalization in surgery department. No patient was smoker. Two of them had a known thoracic or pelvic endometriosis. The initial surgery was video assisted thoracic surgery with a parietal pleurectomy and twice a mesh upon the diaphragm. There were no immediate postoperative complications, and the average length of stay was 6.6 days (5.9). Two patients had adjuvant hormonal therapy. All patients had at least one recurrence and three of them had redo surgery. CONCLUSION: The diagnosis of catamenial PNO must be mentioned in any woman who has a spontaneous pneumothorax right in catamenial period. Endometriosis should be systematically sought. A standardized therapeutic approach to establish the role of surgery and the most appropriate technique as well as the appropriateness and duration of peroperative hormonal therapy remains to be defined.


Subject(s)
Menstruation/physiology , Pneumothorax/physiopathology , Pneumothorax/therapy , Adult , Endometriosis/complications , Endometriosis/drug therapy , Female , Humans , Length of Stay/statistics & numerical data , Pleura/surgery , Pleurodesis , Pneumothorax/complications , Recurrence , Reoperation , Retrospective Studies , Surgical Mesh , Thoracic Surgery, Video-Assisted
13.
Rev Pneumol Clin ; 68(2): 117-22, 2012 Apr.
Article in French | MEDLINE | ID: mdl-22364834

ABSTRACT

Pulmonary parasitosis is scarcely encountered in France, and its diagnosis is quite difficult. If numerous parasites can be responsible for respiratory symptoms, only few of them can develop in the lung parenchyma and lead to complications necessitating a surgical treatment. The most common example is the hydatic disease of the lung. The authors review the biological cycles, clinical forms, diagnostic and treatment principles of those main lung parasites, which deserve surgical consideration.


Subject(s)
Lung Diseases, Parasitic/surgery , Pulmonary Surgical Procedures/statistics & numerical data , Amebiasis/diagnosis , Amebiasis/surgery , Diagnosis, Differential , Echinococcosis, Pulmonary/diagnosis , Echinococcosis, Pulmonary/surgery , Humans , Lung Diseases, Parasitic/diagnosis , Paragonimiasis/diagnosis , Paragonimiasis/surgery , Pulmonary Surgical Procedures/methods
14.
Rev Mal Respir ; 28(2): 152-63, 2011 Feb.
Article in French | MEDLINE | ID: mdl-21402230

ABSTRACT

INTRODUCTION: Blunt chest trauma is a frequent injury and it can be difficult to evaluate its seriousness. The risk of acute decompensation because of an occult thoracic lesion is a significant and justified cause for concern. STATE OF ART: As is common in the case of trauma to the torso, few studies are available to guide the development of structured recommendations about the diagnosis and management of such injuries. PERSPECTIVES: The authors review the anatomical and physiological knowledge relevant to this kind of injury. They propose a standardized management for the diagnosis and emergency management of blunt chest trauma. CONCLUSIONS: The management of blunt chest trauma should include a very systematic first evaluation to avoid diagnostic pitfalls and decrease the risk of subsequent respiratory failure.


Subject(s)
Thoracic Injuries/diagnosis , Thoracic Injuries/therapy , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Decision Trees , Humans , Thoracic Injuries/complications , Thoracic Injuries/physiopathology , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/physiopathology
16.
Rev Pneumol Clin ; 66(1): 3-16, 2010 Feb.
Article in French | MEDLINE | ID: mdl-20207291

ABSTRACT

Mediastinal tumors are relatively uncommon, usually incidentally discovered on a chest X-ray in asymptomatic patients. Young adults are particularly concerned. Mediastinal masses represent a group of heterogeneous histological type cell. A definite diagnosis is essential leading to an adequate prompt therapeutic strategy when either benign disease or aggressive malignant tumor is conceivable. Indeed the therapeutic management of such tumors could be strictly medical, requiring exclusive surgical approach or includes a multimodal treatment. Clinical examination and imaging are important tools in the diagnostic approach. However the specific diagnosis could be complex and requires histological confirmation by an experienced pathologist after examination of large biopsies of the tumor. Several investigations, including surgical invasive exploration, should be quickly requested in order to achieve a final diagnosis and refer patients in an adequate therapeutic scheme without delay. The aim of this article is to point out the available diagnostic tools in mediastinal masses, including surgical approach, and to identify the role of surgical resection in specific subtypes.


Subject(s)
Mediastinal Neoplasms/pathology , Mediastinal Neoplasms/surgery , Adult , Diagnosis, Differential , Goiter/diagnosis , Goiter/pathology , Goiter/surgery , Humans , Lymph Node Excision , Lymphatic Metastasis/pathology , Lymphoma/diagnosis , Lymphoma/pathology , Lymphoma/surgery , Mediastinal Neoplasms/diagnosis , Mediastinoscopy , Mediastinum/pathology , Mediastinum/surgery , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Germ Cell and Embryonal/surgery , Thoracotomy , Thymoma/diagnosis , Thymoma/pathology , Thymoma/surgery , Thymus Neoplasms/diagnosis , Thymus Neoplasms/pathology , Thymus Neoplasms/surgery , Tomography, X-Ray Computed , Video Recording , Young Adult
17.
Rev Pneumol Clin ; 66(1): 71-80, 2010 Feb.
Article in French | MEDLINE | ID: mdl-20207299

ABSTRACT

Acute mediastinitis is a life-threatening complication (20 to 40 % of mortality) secondary to oropharyngeal abscesses, neck infections or oesophageal leak spreading into the mediastium. Early diagnosis and optimal therapeutic approach are crucial for patient survival. CT scanning of the cervical and thoracic area is a useful tool for diagnosis and follow-up. Treatment is based on broad-spectrum antibiotherapy, adequate surgery, mediastinal drainage, and treatment of possible organ failure. There is no surgical standardized attitude. Mini-invasive approach could be satisfactory when prompt diagnosis is established and the thoracic drainage is effective. Repeated postoperative CT scanning and close clinical and laboratory monitoring could make an additional thoracotomy a second-line procedure.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Mediastinitis/surgery , Postoperative Complications/surgery , Surgical Wound Infection/surgery , Acute Disease , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Drainage , Follow-Up Studies , Humans , Mediastinitis/diagnosis , Mediastinitis/etiology , Mediastinum/pathology , Mediastinum/surgery , Methicillin-Resistant Staphylococcus aureus/drug effects , Microbial Sensitivity Tests , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Reoperation , Staphylococcal Infections/diagnosis , Staphylococcal Infections/etiology , Staphylococcal Infections/surgery , Surgical Wound Infection/diagnosis , Surgical Wound Infection/etiology , Thoracotomy , Tomography, X-Ray Computed
18.
Med Trop (Mars) ; 70(1): 9-10, 2010 Feb.
Article in French | MEDLINE | ID: mdl-20337108

ABSTRACT

The purpose of this report is to describe a simple, reproducible technique for pleural drainage. This technique that requires scant resources should be used only in life-threatening situations calling for pleural drainage. It is not intended to replace conventional techniques.


Subject(s)
Drainage/methods , Pleural Effusion/therapy , Drainage/instrumentation , Emergency Treatment , Humans
19.
Med Trop (Mars) ; 68(5): 529-32, 2008 Oct.
Article in French | MEDLINE | ID: mdl-19068989

ABSTRACT

Management of recent diaphragm injury is challenging. The purpose of this report is to describe two patients who presented injuries to the left diaphrgmatic cupola, i.e., rupture due to blunt trauma in Europe and a stab wound in Africa. The value of laparoscopy for diagnosis and treatment are discussed in these contrasting settings.


Subject(s)
Diaphragm/injuries , Diaphragm/surgery , Laparoscopy , Wounds, Nonpenetrating/surgery , Wounds, Stab/surgery , Female , France , Humans , Middle Aged , Senegal
20.
Rev Mal Respir ; 25(6): 683-94, 2008 Jun.
Article in French | MEDLINE | ID: mdl-18772826

ABSTRACT

Surgery is the cornerstone of treatment for resectable tumours of the oesophagus. Recent advances of surgical techniques and anaesthesiology have led to a substantial decrease in mortality and morbidity. Respiratory complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days. Respiratory complications include sputum retention, pneumonia and ARDS. They are the major cause of morbidity and mortality after oesophageal resection and numerous studies have identified the factors associated with these complications. The mechanisms are not very different from those observed after pulmonary resection. Nevertheless, there is an important lack of definition, and evaluation of the incidence is particularly difficult. Furthermore, respiratory complications are related to many factors. Careful medical history, physical examination and pulmonary function testing help to identify the risk factors and provide strategies to reduce the risk of pulmonary complications. Standardized postoperative management and a better understanding of the pathogenesis of pulmonary complications are necessary to reduce hospital mortality. This article discusses preoperative, intraoperative, and postoperative factors affecting respiratory complications and strategies to reduce the incidence of these complications after oesophagectomy.


Subject(s)
Esophageal Neoplasms/surgery , Esophagectomy/adverse effects , Lung Diseases/etiology , Postoperative Complications , Respiratory Distress Syndrome/etiology , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Chylothorax/etiology , Female , Hemothorax/etiology , Hospital Mortality , Humans , Immunosuppression Therapy/adverse effects , Incidence , Lung Diseases/epidemiology , Lung Diseases/mortality , Lung Diseases/prevention & control , Male , Pneumonia/etiology , Postoperative Complications/prevention & control , Respiration, Artificial/adverse effects , Risk Factors , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...