Predicting heat process efficiency in thermal processes when bacterial inactivation is not log-linear.

The food industry widely uses the F-value which considers microbial log-linear inactivation, while microbial heat inactivation may result in a non-log-linear inactivation pattern due to genetic or phenotypical heterogeneity. This may yield discrepancies in predicting microbial heat inactivation under dynamic conditions of heat treatment. In this paper, we suggest the calculation of the equivalent time of heat treatment at a given temperature to overcome these constraints. To validate our proposal, the heat inactivation of Bacillus pumilus, showing non-log-linear behavior, was predicted for 4 different heat inactivation profiles and bacterial enumeration was performed to determine whether prediction errors were acceptable. When the proportion of residuals in an acceptable zone from 1 log (fail safe) to 0.5 log (fail dangerous) was greater or equal to 70%, the model was considered as acceptable for predictions of the tested data. The new approach gave four different temperature profiles, with 96, 85, 85 and 100% of the residuals in the acceptable zone, indicating satisfactory prediction. Thus the proposed practical alternative to simulate microbial heat inactivation kinetics is able to extend the F-value to non-log-linear inactivation patterns.

[Perianal basal cell carcinoma]. / Carcinome basocellulaire périanal.

INTRODUCTION: The perianal localisation of a basal cell carcinoma is exceptional. Its long term progression and the modalities for its treatment should be known. OBSERVATION: A 66 Year-old man was referred for a non-regressive haemorrhoidal thrombosis. He presented with a painless but hemorrhagic lesion of the anal-cutaneous junction that had not progressed much over 5 Years but which did not heal. Following exeresis and biopsy, the anatomopathological exploration concluded in an ulcerous-nodular basal cell carcinoma. COMMENTS: The treatment of perianal basal cell carcinomas consists in the local exeresis of the tumour. Of good prognosis, the possibility of a local relapse however requires strict follow-up.

[Black esophagus associated with hypothermia]. / Oesophage noir associé à une hypothermie.

The authors report a clinical case concerning a necrotizing esophagitis following severe hypothermic shock. They recall the usual aetiology of the "black esophagus", emphasize the importance of ischemia and the multispeciality management of this very unfrequent disease.

[Spontaneous internal carotid artery dissection]. / Dissection spontanée de l'artère carotide interne.

Spontaneous carotid artery dissection is one of the main causes of stroke in young adults. We report two cases occurring after non-traumatic hyperextension of the head. Most of these events result from minor head trauma. Some family history cases would suggest the possibility of an underlying artery wall disorder. The favorable natural history of carotid dissection emphasizes the need for a noninvasive approach for diagnosis. Delayed diagnosis may lead to poor prognosis. Ultrasonography and magnetic resonance angiography are adequate for diagnosis.

[Surgical abstention in closed injuries of the spleen]. / A propos de l'abstention chirurgicale dans les traumatismes fermés de la rate.

Splenic conservation avoids the overwhelming postsplenectomy infection. The high percentage of patients treated by noninvasive procedures would be due to the simple clinical course of splenic trauma and precision of diagnosis, using CT scan. Only clinical evaluation could provide further information on the indications for surgical treatment, as there is no available score regarding the value of CT scan for choosing the therapeutical option. Non-operative management of splenic ruptures should be considered in selected patients in whom hemodynamics is stable and closely monitored.

Blunt injury to the common iliac artery.

OBJECTIVES AND DESIGN: iliac artery lesion after blunt trauma is uncommon, with only 12 previously reported cases. We report nine patients treated in two French teaching hospitals over a six-year period. Mechanism, symptomatology, treatment and outcome were analysed. MATERIAL AND METHOD: All patients were male with a mean (range) age of 29 (16-43) years. Median delay to operative repair was 15 days. Through an extraperitoneal approach PTFE grafts were used in five cases and autogenous graft in four. RESULTS: Morbidity was 22%. Reoperation was necessary in two cases at a mean follow-up of 48 months, at which time all patients were asymptomatic with normal pulses. CONCLUSION: Clinicians should be alert to the possibility of this injury. An arteriography for Doppler ultrasound should be performed. Treatment is mainly surgical and produces excellent long-term results.

[Comparison of magnetic resonance angiography with injection of gadolinium and conventional arteriography of the ilio-femoral arteries]. / Comparaison de l'angiographie par résonance magnétique avec injection de gadolinium et de l'artériographie conventionnelle des axes ilio-fémoraux.

Twenty-three patients underwent conventional arteriography and 3D contrast enhanced magnetic resonance angiography explorations. The study was limited to the iliofemoral arteries (13 segments for each patient). Each segment was classified as having 0-49%, 50-99% or 100% stenosis. Overall results were excellent with K = 0.822, sensitivity 92% and specificity 93%. Segment by segment analysis corroborated the overall results except for the internal iliac arteries and the deep femoral arteries, demonstrating the limitations of this technique in this series.

[Lesions of the iliac arteries secondary to closed traumas. Apropos of 5 cases]. / Lésions des artères iliaques secondaires à des traumatismes fermés. A propos de 5 cas.

Lesions of the iliac arteries after blunt trauma is uncommon. We observed 5 cases in our unit from 1992 to 1995. This pathology usually is seen in young men and the diagnosis often is made late. A Doppler examination and arteriography should be made in case of clinical doubt. Treatment is exclusively surgical. We present the mechanism of the arterial lesions, the symptomatology caused by the lesions and the therapeutic modalities.

[Posterior trans-anal-sphincter approach in the management of urethro-prostate-rectal fistula]. / La voie postérieure trans-ano-sphinctérienne dans la prise en charge des fistules urétro-prostato-rectales.

Uretroprostatorectal fistulas occur rarely, often due to trauma or iatrogenic causes. We observed a case caused by a gun wound and present our surgical route for treatment. The deep situation of these fistulae explains the difficulty in surgical access. Several routes have been described. We used the posterior transanosphincter route proposed by York Mason. This technique has the advantage of direct access for the fistula. Success rate is high and morbidity is limited. No fecal incontinence has been reported in the literature.

[Laparoscopic resection of ileo-cecal tuberculosis]. / Résection laparoscopique d'une tuberculose iléo-caecale.

Rarely seen in industrialised countries, ileo-caecal tuberculosis does not require surgery unless complications or diagnosis uncertainly occur. When laparotomy is contre indicated in presence of chronical respiratory disease, laparo-assisted ileo-caecal resection is an interesting alternative to classical surgery as it has less effect on ventilation. This laparo-assisted ileo-caecal resection appears to the first reported in presence of intestinal tuberculosis.

[Osteoblastomas of the coccyx. Apropos of a case. Review of the literature]. / Les ostéoblastomes du coccyx. A propos d'une observation. Revue de la littérature.

A 24-year-old man presented with a painful and invalidating coccyx. Exploration revealed a bony lesion involving parts of 2nd and all of the 3rd coccygeal vertebrae. The pathology examination of the surgical specimen revealed the diagnosis of benign osteoblastoma of the coccyx. This exceptional localization required complete surgical resection going into healthy tissues to allow a full histological study and to ensure the absence of relapse. Post-operative follow-up was uneventful and the functional result was excellent.

[Divided pancreas. General review apropos of 6 cases]. / Le pancréas divisum. Revue générale à partir de six observations.

The aim of this work is to perform a general review of pancreas divisum. Six cases are reported. A clinical and therapeutic study is made, successively studying the circumstances of discovery, the morphological and functional studies, and the therapeutic methods. A discussion underlines the learnings and contradictions of the literature about this issue.

[Carotid injuries. Apropos of 5 cases]. / Plaies des carotides. A propos de 5 cas.

The authors use a series of 5 treated carotid wounds to identify the characteristics of these lesions and their management. The gravity of carotid wounds is due to the risk of hemorrhage as well as that of respiratory distress and secondary neurological deficit. Controversy persists regarding the legitimacy of revascularisation procedures in the presence of neurological lesions and, according to the majority of authors, such an approach is recommended unless the patient is in coma.

[Gunshot wounds of the ureter]. / Les plaies par balle de l'uretère.

Lesions of the ureter caused by penetrating wounds of the abdomen rare a are complication of abdominal gunshot wounds, of which the reported incidence is 2 to 17%. The preoperative diagnosis is difficult and unrecognized initially in every third case. There are no early clinical signs of ureteral lesions. There is often no hematuria. Only IVP can make the preoperative diagnosis possible. As a matter of fact, the diagnosis will often be established by the surgical exploration made during the laparotomy required by the extent of the associated lesions. The ureteral blast contusion is an important cause of secondary necrosis with fistula. The treatment is mainly based on ureteroureterostomy after debridement. The transanasmotic drainage of urine is controversial. Mortality results from associated abdominal lesions and morbidity consists in a risk of secondary nephrectomy.

[Cancer of the urachus. A rare form of tumors of the bladder]. / Le cancer de l'ouraque. Une forme rare des tumeurs de vessie.

Cancers of the middle umbilical fold are very infrequent, making up 0.1% to 0.7% of all bladder tumors. This type of tumor affects male subjects in 60% to 75% of cases, in the 5th or 6th decade of life. In more than 90% of all cases, the lesion is a mucosecretory adenocarcinoma developing from embryonic remains within the wall of the bladder and respecting the superficial urothelium of the bladder, which is affected only secondarily, contrary to what occurs in the other adenocarcinomas of the bladder. The pathogenesis remains controversial, especially the role of middle umbilical fold patency and of bladder carcinogens. The diagnosis is most often established late, because of a long clinical latency. It is mainly based on ultrasonography and computed tomography. Explorations of the bladder are useful only at an advanced stage. The prognosis is very poor, survival at 5 years ranging from 6.5% to 25% according to the authors. The treatment is mainly surgical. Only extensive exeresis with partial cystectomy extending to the peri- and supravesical environment, including the peritoneum and the umbilicus, and associated with pelvic lymphadenectomy may give some hope. Chemotherapy and radiation therapy, either alone or complementary, are disappointing. The prognosis may be improved only by an early diagnosis.