Boerhaave's syndrome initially presented with sore throat and cough complicated by a bilateral pneumothorax.

A 14-year-old male was admitted to the Emergency Department with sore throat and cough. One hour after his admission, he presented a hemodynamic compromise with a respiratory failure. The thoracic tomodensitometry highlighted a tension bilateral pneumothorax and mediastinum consecutive to an esophageal rupture in the left posterolateral wall also known as Boerhaave's syndrome which was treated successfully with a non-operative management. To avoid a recurrence of bilateral pneumothorax, a left pleuroscopy with talc pleurodesis was performed.

Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report.

INTRODUCTION: Pancreatic cancer is a rare disease with a high mortality rate, for which complete surgical resection, when possible, is the preferred therapeutic. Pancreaticoduodenectomy represents the surgical technique of choice. Abdominal surgeons can be faced with the challenge of patients with a history of coronary artery bypass graft in which the right gastro-epiploic artery is used. CASE REPORT: We report the case of a patient with an adenocarcinoma of the pancreatic head, stage IIA, having previously undergone a triple coronary artery bypass, one of which being a right gastro-epiploic graft. Our challenge was underlined by the necessity of a complete oncological resection through a cephalic pancreaticoduodenectomy while preserving the necessary cardiac perfusion via the right gastro-epiploic artery. CONCLUSION: We have been able to preserve a right gastro-epiploic artery as a coronary bypass during a cephalic pancreaticoduodenectomy for a cephalic pancreatic adenocarcinoma. We have successfully been able to preserve and re-implant the right gastro-epiploic artery to the origin of the gastroduodenal artery while insuring R0 resection of the tumor. A coronary artery bypass using the right gastro-epiploic artery should therefore not be considered as an obstacle to a Whipple's procedure if total oncological resection is obtainable.

[The flexibility of family medicine]. / La flexibilité en médecine générale.

We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.

Transinguinal preperitoneal groin hernia repair using a preperitoneal mesh preformed with a permanent memory ring: a good alternative to Lichtenstein's technique.

PURPOSE: The transinguinal preperitoneal (TIPP) technique uses a preperitoneal mesh preformed with a permanent memory ring, which greatly facilitates application of Rives' technique. The purpose of this retrospective study was to evaluate our primary results by systematic clinical and ultrasound evaluations more than 1 year after surgery. METHODS: This unicentric study included all consecutive adult patients treated with surgery for a groin hernia by the same surgeon using the same technique between December 2006 and December 2008. Any patient who participated in this study had both a systematic clinical and ultrasound control between 6 months and 3 years after surgery. RESULTS: In this study, we performed 145 hernia repairs. There was no infection of the mesh and no clinical recurrence; additionally there was an ultrasound recurrence (n = 3) in 2% of asymptomatic patients and chronic pain in 4.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities. CONCLUSIONS: It is feasible to correct a groin hernia using a preperitoneal preformed mesh with a permanent memory ring. Our study confirms the positive results of Pélissier and colleagues (Pélissier and Ngo, Ann Chir 131:590-594, 2006; Pélissier et al. J Chir 144(4):5S35-5S40, 2007; Pélissier et al. Hernia 11:229-234, 2007; Pélissier et al. Hernia 12:51-56, 2007) and Berrevoet et al. (Hernia 13:243-249, 2009; Langenbeck's Arch Surg 395:557-562, 2010) and is the first study to use a systematic clinical and ultrasound control more than 1 year after surgery. This technique has a low rate of complications, including ultrasound recurrence in 2% of patients without any clinical recurrence and chronic pain in 4.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities. This technique consisted of the placement of a patch in the preperitoneal space, which combines the benefits of the anterior approach (i.e., easy technique, short learning curve, low cost) and the preperitoneal placement of the mesh (less recurrence, less pain). This procedure is a good alternative to Lichtenstein's technique.