[Theoretical risk management and legitimacy of the precautionary principle in medicine. Look back at HIV contamination through blood transfusion in France, twenty years ago]. / La gestion d'un risque potentiel et la légitimité du principe de précaution en médecine. Regard vingt ans après sur la contamination transfusionnelle par le VIH en France.

The precautionary principle first appeared in France during the health crisis following the contamination of patients with HIV via blood transfusion. This study analyses whether the risk associated with blood transfusion was taken into account early enough considering the context of scientific uncertainty between 1982 and 1985. The aim was to evaluate whether a precautionary principle was applied and whether it was relevant. First, we investigated the context of scientific uncertainty and controversies prevailing between 1982 and 1985. Then we analysed the attitude and decisions of the French authorities in this situation to determine whether a principle of precaution was applied. Finally, we explored the reasons at the origin of the delay in controlling the risk. Despite the scientific uncertainties associated with the potential risk of HIV contamination by transfusion in 1983, we found that a list of recommendations aiming to reduce this risk was published in June of that year. In the prevailing climate of uncertainty, these measures could be seen as precautionary. However, the recommended measures were not widely applied. Cultural, structural and economic factors hindered their implementation. Our analysis provides insight into the use of precautionary principle in the domain of blood transfusion and, more generally, medicine. It also sheds light on the expectations that health professionals should have of this principle. The aim of the precautionary principle is to manage rather than to reduce scientific uncertainty. The principle is not a futile search for zero risk. Rather, it is a principle for action allowing precautionary measures to be taken. However, we show that these measures must appear legitimate to be applied. This legitimacy requires an adapted decision-making process, involving all those concerned in the management of collective risks.

[The precautionary principle applied to blood transfusion. What is its impact on practices and risk management?]. / Le principe de précaution appliqué à la transfusion sanguine: quel impact sur les pratiques et la gestion des risques?

The precautionary principle has boomed in the French public health sector through blood transfusion. There has been, however, no perambulatory reflection on the definition, objectives, methods of application or consequences of this principle. The question of the pertinence of its application remains unanswered. This study, based on interviews with blood transfusion practitioners, aims to establish their perceptions of the precautionary principle's application in this specific field and of its consequences in terms of risk management and patients' rights. The pros and cons of this application are analysed based on these perceptions. According to our analysis, the precautionary principle seems to be born of confusion. It is seen more as a way to protect decision makers than patients and, if taken to extremes, could prejudice medical logic. Nevertheless, it also brings measures which renew and encourage evolution in transfusion risk management.

[Factors of risk perception and risk acceptability: a contribution for the knowledge of the perception of the risk associated with blood transfusion]. / Les facteurs de perception et d'acceptabilité du risque: un apport pour la connaissance des représentations du risque transfusionnel.

The concept of risk cannot be limited to simply knowing the probability of occurrence and the seriousness of the damages caused. It's a matter of social construction and numerous elements contribute towards its perception and acceptability. These elements have been studied for 20 years or so. Some of these elements influence risk perception such as awfulness, unfamiliarity, the number of people exposed to it, other elements influence its acceptance such as individual perceptions, social factors, ethics and equity. Their knowledge allows a better understanding of the evolution of perception and of the risk acceptability in general and transfusion risk in particular.

[Voyage to Bahnars country, people living in the high plateaus of central Vietnam]. / Voyage au pays des Bahnars, Peuple des Hauts Plateaux du centre Vietnam.

Southeast Asia was born from the collision between the Indian subcontinent and mainland China. Vietnam owes its 54 ethnic groups and four languages to a succession of migrations over the milleniums. The high plateaus are inhabited by a multitude of small ethnic groups commonly referred to as the "Moi". Vietnamity and the Association for Aid to the Ethnic Minorities of Vietnam are dedicated to developing and implementing cooperative projects with Vietnam. Living in the remote hinterland, the now less than one million mountain people of the High Plateaus were untouched by Indian and Chinese influences and remained independent until French colonisation which had only minor effects on their culture. During an expedition to the high plateaus, a privileged group sent by Vietenamity encountered one of these peoples, the Bahnars. In the context of a village festival, the authors describe the traditional way of life and beliefs of the Bahnar people.

[Highly malignant tumors of the uterine corpus at the Hospital Principal in Dakar. Apropos of 8 cases in 1986-1987]. / Tumeurs corporéo-utérines de haute malignité à l'Hôpital Principal de Dakar. A propos de 8 cas en 1986-1987.

8 observations of corporeo-uterine tumors, observed during 2 years (1986-1987) at the Hospital Principal of Dakar (Senegal), are expounded. Their connected chemical, surgical and evolutive expression allowed us to gather 4 "Carcinoma" (epithelial malignant tumours), 2 sarcomas (conjunctival malignant tumours) and 2 uterine corpus extensive choriocarcinoma (trophoblastic tumours). Late detected, unfortunately developed, these tumours are characterized by their high seriousness and the appalling prognosis they mean (the victim doesn't generally survive more than 10 months).

[Right ileocolonic intubation after resection of the terminal ileum for generalized peritonitis caused by ileal perforation. An African experience with 33 cases]. / Intubation iléo-colique droite après résection de l'iléon terminal pour péritonite généralisée par perforation iléale. Expérience africaine de 33 cas.

Generalized peritonitis due to ileal perforation is common in Africa, and is caused by typhoid fever in most cases. For various reasons, the patients arrive at hospital in a poor general condition. In spite of combined intensive care and surgery, the general evolution of the disease resulted in a high mortality rate. All surgical techniques requiring sutures on a poor-quality ileon, ie. excision and suture, limited segmental resection or extensive ileal resection, most often lead to the breakdown of suture lines, so that the patient enters the vicious circle of repeated peritonitis and hazardous re-operations. Even exteriorized suture lines turn into fistulae, and temporary terminal ileostomy requires an amount of maintenance that is sometimes difficult to ensure in Africa. The technique proposed by the authors was developed in the department of surgery of the Dakar Main Hospital and has several advantages: It is a simple and quick procedure, which does not require the surgeon to be very experienced and can be performed in underequipped hospitals. There is no procedure-associated mortality. Morbidity decreases as the surgeon's experience increases. GI continuity can be established even in a septic environment. No second-look operation is necessary, so that the stay at hospital becomes shorter and the costs of treatment lower. Lastly, this type of restoration can be applied to other indications such as right colectomy and ileocolic or transverse ileal intubation.

[Vaginal hysterectomy: its place in surgical practice overseas as related to the experience of the Principal Hospital of Dakar]. / L'hystérectomie vaginale: sa place en pratique chirurgicale outre-mer à propos de l'expérience de l'Hôpital Principal de Dakar.

The authors report on their surgical practice of vaginal hysterectomy at the Principal Hospital of Dakar. First, they assign a place to the frequency of this technic. Then, they recall the major technical details, underlining advantages and limits. They conclude in favour of better knowledge and performing this technic more often, while recognizing some limits related to the pathologic context overseas.

[Surgical pelviperitonitis and the African gynecologic complex]. / Pelvipéritonites chirurgicales et complexe gynécologique africain.

From the analysis of 28 records in the gynecological Department of the Hospital Principal in Dakar, all of them recording cases of pelviperitonitis having demanded a surgical intervention, it seems permissible to the authors to maintain the denomination, full of imagery, of "Gynecologic African Complex". They define it as appearing in a peculiar socio-economical environment (in Africa but also in the Third World) and characterised anatomically by an inflammatory pelviperitoneal syndrome presenting a large anatomic diversity. In the studied records, the authors sorted out 14 cases with an acute clinical aspect and 14 with a chronic one. These 28 cases represented 1.5% of the admissions and 5% of the operated patients in the gynecologic Department. The aspect "complex", linked with the polymorphism of the diagnosed lesions (among them 2 tubal tuberculosis, 1 peritoneal tuberculosis, 2 genital bilharziosis) and their frequent association, constitutes a surgical entity about which therapeutic tactics has to be adapted and reasonably mutilating. The concern of preservation must take into consideration future evolution of surgical consequences, genital and obstetrical future of women often young.

[Long trips of intra-uterine devices in tropical areas (author's transl)]. / Les grandes migrations des dispositifs intra-utérins sous les tropiques.

Report of a case in which an unnoticed intra-uterine device was fortuitously found in the left hypochondrium. Reflexions on mecanisms of migration and required precautions.

PIP: The article reports on 1 case of dislocation of IUD from the uterine into the abdominal cavity, dislocation discovered through radiography, after the patient had delivered a dead fetus. Missing IUD strings do not necessarily signify expulsion of the device; radiography is an essential tool of diagnosis. Uterine perforation can happen at the time of insertion; this is why IUD insertions should be done only by skilled and experienced personnel.