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Resume Les pathologies le plus frequentes au retour de voyage a l’etranger sont les infections gastro-intestinales, les maladies febriles et les problemes dermatologiques. L’evaluation d’un enfant febrile de retour de voyage est clinique : verification des antecedents et des vaccinations, recherche d’autres cas au contact, signes fonctionnels et physiques, caracteristiques du voyage. Un bilan paraclinique de debrouillage complete souvent l’evaluation pour une orientation syndromique. Si les causes de fievre sont surtout cosmopolites, la gravite des pathologies exotiques doit les faire rechercher en priorite. Le paludisme doit etre evoque devant toute fievre en provenance d’Afrique subsaharienne. Le diagnostic repose sur l’association d’un frottis sanguin et d’un test sensible (goutte epaisse, polymerase chain reaction [PCR]) ou d’un test de diagnostic rapide (pour Plasmodium [P]. falciparum). Les criteres clinicobiologiques de gravite sont essentiels pour orienter et traiter le patient. En cas d’acces non complique a P. falciparum, le traitement repose sur une therapie combinee a base d’artemisinine (ACT), artemether-lumefantrine ou artenimol-piperaquine. Les acces graves sont traites par l’artesunate intraveineux, puis un ACT oral. Dengue, chikungunya et infection a virus Zika ont des caracteristiques cliniques communes (association fievre-eruption-arthralgies, traitement symptomatique). En cas de dengue, il faut surveiller l’apparition de signes d’alerte qui pourraient faire craindre une evolution pejorative. Le chikungunya est grave en cas de transmission per partum, avec un risque d’encephalite neonatale. Chez l’enfant, le Zika est a- ou peu symptomatique. Mais en cas d’infection pendant une grossesse, le risque est celui d’une embryofœtopathie. Le diagnostic de ces arboviroses repose sur la PCR a la phase aigue et la serologie secondairement. La symptomatologie de la typhoide est peu specifique, justifiant la pratique d’hemocultures systematiques devant une fievre du retour. Son traitement repose sur les cephalosporines de troisieme generation ou la ciprofloxacine, mais les resistances augmentent. Au total, la diversite des etiologies d’une fievre de retour et la gravite potentielle des infections importees imposent une reflexion sur le parcours de soins de ces patients, en particulier vis-a-vis du risque de fievre hemorragique.

The mechanisms that govern the vertical growth of seep carbonates were deciphered by studying the sedimentary architecture of a 15 m thick, 8 m wide column of limestone encased in deep-water marl in the middle Callovian interval of the Terres Noires Formation in the SE France Basin. The limestone body, also called “pseudobioherm”, records intense bioturbation, with predominant traces of the Thalassinoides/Spongeliomorpha suite, excavated by decapod crustaceans. Bioturbation was organized in four tiers. The uppermost tier, tier 1, corresponds to shallow homogenization of rather soft sediment. Tier 2 corresponds to pervasive burrows dominated by large Thalassinoides that were later passively filled by pellets. Both homogenized micrite and burrow-filling pellets are depleted in 13C in the range from −5 ‰ to −10 ‰. Tier 3 is characterized by small Thalassinoides that have walls locally bored by Trypanites; the latter represent tier 4. The diagenetic cements filling the tier-3 Thalassinoides are arranged in two phases. The first cement generation constitutes a continuous rim that coats the burrow wall and has consistent δ13C values of approximately −8 ‰ to −12 ‰, indicative of bicarbonate originating from the anaerobic oxidation of methane. In contrast, the second cement generation is dominated by saddle dolomite precipitated at temperatures >80 ∘C, at a time when the pseudobioherm was deeply buried. The fact that the tubes remained open until deep burial means that vertical fluid communication was possible over the whole vertical extent of the pseudobioherm up to the seafloor during its active development. Therefore, vertical growth was fostered by this open burrow network, providing a high density of localized conduits through the zone of carbonate precipitation, in particular across the sulfate–methane transition zone. Burrows prevented self-sealing from blocking upward methane migration and laterally deflecting fluid flow. One key aspect is the geometric complexity of the burrows with numerous subhorizontal segments that could trap sediment shed from above and, hence, prevent their passive fill.

Las enfermedades mas frecuentes al regresar de un viaje al extranjero son las infecciones gastrointestinales, las enfermedades febriles y los problemas dermatologicos. La evaluacion de un nino febril al regreso de un viaje es clinica: verificacion de los antecedentes y las vacunaciones, busqueda de otros casos en contacto, signos funcionales y fisicos, y caracteristicas del viaje. Unas pruebas complementarias de rutina completan a menudo la evaluacion para una orientacion sindromica. Si bien las causas de fiebre son, sobre todo, cosmopolitas, la gravedad de la enfermedad exotica obliga a buscarlas prioritariamente. El paludismo debe sospecharse ante una fiebre procedente de Africa subsahariana. El diagnostico se basa en la asociacion de un frotis sanguineo y una prueba sensible (gota gruesa, reaccion en cadena de la polimerasa [PCR]) o una prueba de diagnostico rapido (para Plasmodium falciparum). Los criterios clinico-biologicos de gravedad son esenciales para orientar y tratar al paciente. En caso de acceso no complicado por P. falciparum, el tratamiento se basa en un tratamiento combinado a base de artemisinina (ACT), artemeter-lumefantrina o artenimol-piperaquina. Los accesos graves se tratan con artesunato intravenoso, seguido de ACT oral. Dengue, chikungunya e infeccion por virus Zika tienen caracteristicas clinicas comunes (fiebre-erupcion-artralgias, tratamiento sintomatico). En caso de dengue, conviene controlar la aparicion de signos de alerta, que podrian hacer temer una evolucion negativa. El chikungunya es grave en caso de transmision en el parto, con un riesgo de encefalitis neonatal. En el nino, el Zika es asintomatico o poco sintomatico. Pero, en caso de infeccion durante el embarazo, el riesgo es el de una embriofetopatia. El diagnostico de estas arbovirosis se basa en la PCR en la fase aguda y en la serologia secundariamente. La sintomatologia de la fiebre tifoidea es poco especifica, lo cual justifica la practica de hemocultivos sistematicos ante una fiebre tras un viaje. Su tratamiento se basa en las cefalosporinas de tercera generacion o el ciprofloxacino, pero las resistencias aumentan. En suma, la diversidad de las etiologias de una fiebre al regreso de un viaje y la potencial gravedad de las infecciones importadas imponen una reflexion sobre el proceso de tratamiento de estos pacientes, en especial en lo referente al riesgo de fiebre hemorragica.

Thyroid-associated ophthalmopathy can result in proptosis. In such cases, orbital decompression surgery is often warranted to reduce the adverse impact on patient quality of life. Due to the anatomical complexity of the orbit, navigation can be of considerable assistance during orbital decompression. The objective of this study was to evaluate the benefits of using a surgical navigation device in orbital decompression surgery. A retrospective study was performed based on patients who underwent decompression surgery with (N+) or without (N-) a navigation device between 1997 and 2017. Included patients had undergone unilateral or bilateral orbital decompression by resection of the orbital floor and medial wall of the orbit. Criteria assessed were the presence of debilitating postoperative diplopia, postoperative proptosis reduction, symmetry of protrusion of the eyeballs, and the duration of surgery. Three hundred and fifty eyes were analysed (191 patients): 205 in the N+ group and 145 in the N- group. Use of the surgical navigation system resulted in a greater proptosis reduction, and this result was statistically significant for the right eyeball (P=0.03). The surgical navigation system had no effect on symmetry of protrusion of the eyeballs or on postoperative diplopia. Setting up the navigation device increased the duration of surgery by 40 minutes on average.

A new type of gas chimney exhibiting an unconventional linear planform is found. These chimneys are termed "Linear Chimneys", which have been observed in 3-D seismic data offshore of Angola. Linear Chimneys occur parallel to adjacent faults, often within preferentially oriented tier-bound fault networks of diagenetic origin (also known as anisotropic polygonal faults, PFs), in salt-deformational domains. These anisotropic PFs are parallel to salt-tectonic-related structures, indicating their submission to horizontal stress perturbations generated by the latter. Only in areas with these anisotropic PF arrangements do chimneys and their associated gas-related structures, such as methane-derived authigenic carbonates and pockmarks, have linear planforms. In areas with the classic "isotropic" polygonal fault arrangements, the stress state is isotropic, and gas expulsion structures of the same range of sizes exhibit circular geometry. These events indicate that chimney's linear planform is heavily influenced by stress anisotropy around faults. The initiation of polygonal faulting occurred 40 to 80m below the present day seafloor and predates Linear Chimney formation. The majority of Linear Chimneys nucleated in the lower part of the PF tier below the impermeable portion of fault planes and a regional impermeable barrier within the PF tier. The existence of polygonal fault-bound traps in the lower part of the PF tier is evidenced by PF cells filled with gas. These PF gas traps restricted the leakage points of overpressured gas-charged fluids along the lower portion of PFs, hence controlling the nucleation sites of chimneys. Gas expulsion along the lower portion of PFs preconfigured the spatial organisation of chimneys. Anisotropic stress conditions surrounding tectonic and anisotropic polygonal faults coupled with the impermeability of PFs determined the directions of long-term gas migration and linear geometries of chimneys. Methane-related carbonates that precipitated above Linear Chimneys inherited the same linear planform geometry, and both structures record the timing of gas leakage and palaeo-stress state; thus, they can be used as a tool to reconstruct orientations of stress in sedimentary successions. This study demonstrates that overpressure hydrocarbon migration via hydrofracturing may be energetically more favourable than migration along pre-existing faults., SCOPUS: ar.j, info:eu-repo/semantics/published

Injuries to stabilizing elements on the medial side of the knee are one of the most common knee ailments. Because of the good healing capacity of these structures, acute injuries are typically treated conservatively. However, valgus laxity near full extension can persist in some patients. This laxity may be the source of instability due to medial joint space opening, which then requires surgical treatment. Various procedures have been described that aim to reproduce the anatomy of the medial collateral ligament (MCL) and the posterior oblique ligament (POL), which work together to stabilize the medial aspect of the knee. However, these are complex open surgical procedures, technically demanding to achieve the favorable isometry, which prevent joint contracture or recurrence of laxity. The purpose of this study was to describe a short construct that minimizes the risk of secondary loss of tension and complies with the principle of favorable anisometry. The graft is positioned in the joint opening axis, between the deep bundle of the MCL and the POL.

Resume Introduction L’analyse des causes d’echec d’une ligamentoplastie du LCA doit permettre de choisir la technique la plus adaptee lors de la reprise chirurgicale afin d’assurer au patient un bon controle de la stabilite rotatoire et de diminuer les risques de ruptures iteratives. Objectif L’objectif de ce travail est d’evaluer les plasties anterolaterales (PAL) dans les reprises de ligamentoplasties du LCA. Hypothese L’hypothese de ce travail etait que les PAL realisees lors des chirurgies de revision du LCA, permettaient d’assurer un bon controle du ressaut sans augmenter les risques de complication. Materiel et methodes Il s’agit d’une etude multicentrique, prospective (sur 24 mois) et retrospective (minimum 3 ans de recul) fondee sur 349 patients, 283 hommes et 66 femmes. Les criteres d’inclusion sont des patients pour lesquels une indication chirurgicale de revision du LCA avec plastie intra-articulaire et PAL a ete retenu suite a un echec de plastie du LCA par autogreffe avec un LCP intact. Les criteres d’exclusion sont les reconstruction du LCA de 1 re intention et les lesions peripheriques mediales et/ou laterale associees. Les patients ont eu une evaluation clinique et radiographique pre- et postoperatoire. Le score IKDC preoperatoire etait en moyenne de 56,5 ± 15,5 avec 96 % de score IKDC C ou D. Resultats Le taux de complications postoperatoires precoces etait de 5 % et postoperatoires tardives de 10,5 %. Au dernier recul, dans 97 % des cas le test de Lachman avait un arret dur. Le ressaut rotatoire etait positif dans 1 % des cas. Le score IKDC subjectif moyen etait de 84,5 ± 13 dont 86,5 % de classe A ou B. Les signes d’arthrose radiographique etaient stables au dernier recul sur les compartiments femorotibial lateral et femoropatellaire, mais en augmentation de 9,7 a 21,2 % sur le compartiment femorotibial medial. Le taux de reruptures etait de 1,2 % et le taux de re-intervention secondaire de 5,4 %. Conclusion La laxite anterieure au dernier recul est similaire aux autres series de revision de la litterature mais le controle du ressaut et le taux de rupture iterative sont inferieurs. Les PAL font partie des techniques a envisager dans l’arsenal therapeutique des chirurgies de reprise du LCA. Type d’etude Etude retrospective et prospective de cohorte niveau IV.

Introduction During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial. Hypothesis ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions. Material and methods Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3 years’ follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28 years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data. Results The average follow-up was 6.8 years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3 mm in 66% of patients and less than 5 mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%. Discussion When compared to historical ACL reconstruction data, combined intra- and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8 years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries. Level of evidence IV, multicenter study.

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Summary Tarsal ectropion and involutional entropion are two frequent age-related lower eyelid malpositions with a mirrored clinical presentation. The recent anatomical confirmation of two layers of lower eyelid retractors makes it possible to conceive of the role of each of these layers in the stability of the two palpebral lamellae and their involvement in the pathogenesis of these two malpositions. This study proposes a theory of common pathogenesis involving an involutional change in only the lower lid retractors, leading to the description of two new clinical-anatomical entities.

Purpose To measure the variations in length during flexion and internal tibial rotation of the 3 different femoral insertions of the anterolateral ligament (ALL) while maintaining a fixed tibia insertion. Methods Twelve fresh-frozen cadaver knees were analyzed using a navigation system. Maximal distance variations of the 3 different anatomic femoral insertions of the ALL were measured during knee flexion and internal tibial rotation at 20° (IR20°) and 90° (IR90°). The 3 different femoral attachments were, as published, at the center of the lateral epicondyle, distal and anterior from this position, and proximal and posterior. Each of these 3 femoral insertions was coupled to the same tibial insertion at the tibial margin, halfway between the tip of the fibular head and the prominence of the Gerdy tubercle. Results During IR20°, variation in the distance between paired points is not different between the proximal-posterior, epicondyle, and distal-anterior femoral insertions. These variations were statistically different during IR90° for the 3 different femoral locations. In increasing degrees of flexion, there was a length decrease between paired points observed with the proximal-posterior position. A length increase was observed for both the epicondyle location and the distal-anterior location. Conclusions The ALL did not reveal an isometric behavior at any of the femoral insertion locations but had different length change patterns during knee flexion and internal tibial rotation at 90°. The proximal and posterior to epicondyle femoral position is the only position with a favorable isometry, as shown by being tight in extension and in internal rotation at 20° and then relaxed when the knee goes to flexion at 120° and during internal rotation at 90°. Clinical Relevance Clinical relevance is significant with respect to optimizing the femoral position of an ALL reconstruction.

Background:Rotational control of the knee is crucial for knee stability. The anterolateral ligament (ALL) has been identified as a potentially important structure involved in rotational control of the knee.Purpose/Hypothesis:The purpose of this study was to determine, utilizing a navigation system, the involvement of the anterior cruciate ligament (ACL), the iliotibial band (ITB), and the ALL in tibial internal rotational control of the knee. The hypothesis was that the ALL would be involved in rotational control of the knee at varying degrees of knee flexion.Study Design:Controlled laboratory study.Methods:Twelve fresh-frozen cadaveric knees were tested in internal rotation at 20° and 90° of flexion and then subsequently tested using a simulated pivot-shift test consisting of coupled axial rotation at 30° of flexion. Serial sectioning of the ACL, ALL, and ITB was performed. On the contralateral knee, sectioning was performed in the reverse order. Measurements were collected using a surgical navigation system before and after each sectioning.Results:After ACL sectioning, an incision of the ALL induced a significant increase in internal rotation (+19.2% [ P = .0002] at 20°; +21.8% [ P = .0029] at 90°) and in coupled axial rotation (+43.0%; P = .0035) compared with the intact knee as well as a significant increase in internal rotation at 90° (+13.4%; P = .009) and in coupled axial rotation (+30.8%; P = .0124) compared with the ACL-deficient knee. After ITB sectioning, an additional ALL section caused a significant increase in internal rotation (+39.0% [ P = .002] at 20°; +63.0% [ P = .0147] at 90°) and in coupled axial rotation (+59.7%; P = .0003) compared with the intact knee as well as a significant increase in internal rotation at 90° (+14.8%; P = .0067) in comparison to the ITB-deficient knee.Conclusion:The ALL is involved in rotational control of the knee at varying degrees of knee flexion and during a simulated pivot shift. Concomitant to an ACL or ITB transection, sectioning the ALL further increased rotational laxity.Clinical Relevance:This laboratory study demonstrated that the ALL provides rotational control of the knee in combination with the ACL and/or ITB.

BACKGROUND Little is known about early-onset neonatal bacterial infections (EONBI) in Madagascar. Our aim was to determine their epidemiology to improve their management. METHODS Inborn neonates at risk for EONBI and admitted in the neonatal unit of 2 tertiary hospitals in Antananarivo, Madagascar, were included in a prospective study from April 2012 to March 2013. Using a clinical algorithm, blood culture, gastric fluid culture and C-reactive protein dosage were performed in newborns at high risk of infection, that is, peri partum fever, prematurity

The following surgical technique is intended for patients with chronic valgus laxity and rotational knee instability. It is a percutaneous 2-bundle ligament reconstruction method that uses the semitendinosus tendon, allowing it to remain pedicled to its distal tibial insertion. The aim is to correct the laxity without otherwise limiting the motion of the knee.

Since the 2007 French guidelines on imported Falciparum malaria, the epidemiology, treatment, and prevention of malaria have changed considerably requiring guidelines for all Plasmodium species to be updated. Over the past decade, the incidence of imported malaria has decreased in all age groups, reflecting the decrease in the incidence of malaria in endemic areas. The rates of severe pediatric cases have increased as in adults, but fatalities are rare. The parasitological diagnosis requires a thick blood smear (or a rapid immunochromatographic test) and a thin blood film. Alternatively, a rapid antigen detection test can be paired with a thin blood film. Thrombocytopenia in children presenting with fever is highly predictive of malaria following travel to a malaria-endemic area and, when detected, malaria should be strongly considered. The first-line treatment of uncomplicated P. falciparum malaria is now an artemisinin-based combination therapy (ACT), either artemether-lumefantrine or artenimol-piperaquine, as recommended by the World Health Organization in endemic areas. Uncomplicated presentations of non-falciparum malaria should be treated either with chloroquine or ACT. The first-line treatment of severe malaria is now intravenous artesunate which is more effective than quinine in endemic areas. Quinine is restricted to cases where artesunate is contraindicated or unavailable. Prevention of malaria in pediatric travelers consists of nocturnal personal protection against mosquitoes (especially insecticide-treated nets) combined with chemoprophylaxis according to the risk level.

Resume Introduction L’infection neonatale bacterienne precoce (INBP) reste une des principales causes de mortalite et morbidite neonatales. La generalisation du depistage du portage vaginal de streptocoque du groupe B (SGB) et de l’antibioprophylaxie per-partum a entraine une diminution de l’incidence des INBP a SGB. Plus de dix ans apres les dernieres recommandations francaises, nous avons evalue les pratiques professionnelles concernant le depistage, le diagnostic et le traitement des INBP en Ile-de-France. Patients et methodes Enquete observationnelle multicentrique, prospective, du 18 au 31 mars 2013, dans 14 maternites volontaires d’Ile-de-France. Tous les enfants nes vivants a 35 semaines d’amenorrhee (SA) ou plus ont ete inclus. Les caracteristiques maternelles, obstetricales, neonatales et les modalites de prise en charge des suspicions d’INBP ont ete recueillies. Resultats La population d’etude a comporte 1194 meres et 1217 nouveau-nes. Parmi ces derniers, 54 % ont eu des prelevements bacteriologiques a la naissance, dont au moins un liquide gastrique. L’indication des prelevements bacteriologiques reposait dans 85 % des cas sur la presence de criteres majeurs ou mineurs definis par l’Agence nationale d’accreditation et d’evaluation en sante (ANAES) en 2002. En outre, plus d’un nouveau-ne sur 4 a eu au moins un prelevement sanguin. Une antibiotherapie a ete administree a 4 % des enfants, comportant la cefotaxime dans pres de deux tiers des cas. Conclusion Une mise a jour des recommandations concernant la prise en charge de l’INBP parait necessaire pour mieux cibler les nouveau-nes a risque et optimiser l’utilisation des antibiotiques. La place des prelevements bacteriologiques a la naissance dans la gestion des suspicions d’INBP est certainement a redefinir.

Evidence is presented that constrains the earliest part of the growth history of a polygonal fault tier. Using high resolution, 3D seismic data from the West African margin, we document the interaction between a shallow buried, wedge shaped polygonal fault tier and pockmarks located at the base of the fault tier. Strongly curved patterns of perturbed polygonal faults are mapped in the shallowest portions of a tier overlying a series of pockmark craters. These perturbed patterns differ markedly from the ‘background’ polygonal pattern developed away from areas of pockmark influence. Perturbation is attributed to local stress effects relating to residual topography of the underlying pockmarks. By analysing the thickness variations of mapped layers within the polygonally faulted tier, we demonstrate that any residual topography was most likely healed after approximately one third of the total tier thickness was deposited. Hence the nucleation of the polygonal faults into their perturbed propagation trajectories must have been established within the first 100–150 m of burial. From these observations of early nucleation in the basal third of a tier, we propose a new model of polygonal fault growth in which individual faults nucleate near the base of a tier at an early stage of burial and then propagate preferentially upwards with basal tips restricted by an underlying mechanically competent unit the base of the tier. Continued growth then shifts the locus of displacement, such that final displacement distributions are more axio-symmetrically disposed with respect to the base and top of the tier.

SFA 2017 - Congrès annuel de la Société Francophone d'Arthroscopie, MARSEILLE, FRANCE, 06-/12/2017 - 09/12/2017; Lors de la ligamentoplastie du LCA, l'adjonction d'une plastie antérolatérale (PAL) a pour but d'améliorer le contrôle de la stabilité en rotation du genou. L'efficacité de cette technique et ses conséquences sur les risques de re-rupture et d'atteinte dégénérative secondaire sont discutées.

Resume Introduction Les plasties anterolaterales (PAL) sont utilisees pour diminuer le risque de rupture iterative apres reconstruction du ligament croise anterieur (LCA) chez les patients a risque. Ces plasties ajoutent un geste a la greffe isolee du LCA qui peut augmenter le temps operatoire et perturber les suites operatoires. L’objectif de cette etude etait d’evaluer le taux de complications precoces. L’hypothese etait que les plasties anterolaterales associees a une plastie du LCA n’augmentent pas le taux de complications par rapport aux plasties isolees. Materiel et methodes Il s’agit d’une etude multicentrique, prospective portant sur 392 patients dont 70 % d’hommes, âges en moyenne de 29,9 ans, operes d’une plastie du LCA avec PAL associee. L’ensemble des evenements indesirables ont ete releves. Resultats La duree moyenne d’hospitalisation a ete de 2 jours avec 46 % de chirurgie ambulatoire. La marche etait acquise en 27 jours en moyenne avec un avantage pour les patients operes avec une technique aux ischio-jambiers. Le taux de complication postoperatoire precoce etait de 12 % dont 1,7 % specifiques a la PAL : douleur, hematome, raideur en flexion et extension, infection. Cinq pour cent de re-interventions ont ete observees la premiere annee avec une majorite d’arthrolyse pour flexum. Le taux de rupture iterative etait de 2,8 % a l’issue de la premiere annee. Discussion Les complications des PAL associees aux plasties intra-articulaires ne sont pas plus importantes que pour les plasties intra-articulaires isolees, sans augmentation du taux d’infection ni de raideur. Les complications liees a la PAL sont faibles, 1,7 %, et sont a mettre en rapport avec des erreurs techniques de fixation ayant engendre des conflits avec les parties molles laterales. Niveau de preuve Niveau IV, etude multicentrique prospective.

Introduction Lateral tenodesis (LT) is performed to limit the risk of iterative tear following anterior cruciate ligament (ACL) reconstruction in at-risk patients. By adding an extra procedure to isolated ACL graft, LT reconstruction increases operating time and may complicate postoperative course. The objective of the present study was to evaluate the rate of early complications. The study hypothesis was that associating ALL reconstruction to ACL reconstruction does not increase the complications rate found with isolated ACL reconstruction. Material and methods A prospective multicenter study included 392 patients: 70% male; mean age, 29.9 years; treated by associated ACL and LT reconstruction. All adverse events were inventoried. Results Mean hospital stay was 2 days, with 46% day-surgery. Walking was resumed at a mean 27 days, with an advantage for patients treated by the hamstring technique. The early postoperative complications rate was 12%, with 1.7% specifically implicating LT reconstruction: pain, hematoma, stiffness in flexion and extension, and infection. There was a 5% rate of surgical revision during the first year, predominantly comprising arthrolysis for extension deficit. The 1-year recurrence rate was 2.8%. Discussion The complications rate for combined intra- and extra-articular reconstruction was no higher than for isolated intra-articular ACL reconstruction, with no increase in infection or stiffness rates. The rate of complications specific to ALL reconstruction was low, at 1.7%, and mainly involved fixation error causing lateral soft-tissue impingement. Level of evidence IV, prospective multicenter study.

Background A careful analysis of the reasons for ACL reconstruction failure is essential to selection of the optimal surgical revision technique designed to ensure good rotational stability and to minimise the risk of re-rupture. Objective To evaluate anterolateral ligament (ALL) stabilisation during revision ACL reconstruction. Hypothesis ALL stabilisation during revision ACL reconstruction provides good rotational stability without increasing the risk of complications. Material and methods This multicentre study included 349 patients, 151 retrospectively and 198 prospectively. There were 283 males and 66 females. Inclusion criteria were an indication for revision ACL reconstruction surgery with combined intra-articular reconstruction and ALL stabilisation after failed autograft ACL reconstruction, and intact PCL. Exclusion criteria were primary ACL reconstruction and concomitant peripheral medial and/or lateral lesions. Each patient underwent a clinical and radiographic evaluation before and after revision surgery. Before revision surgery, the mean IKDC score was 56.5 ± 15.5 and 96% of patients were IKDC C or D. Results Rates were 5.0% for early and 10.5% for late postoperative complications. Lachmann's test had a hard stop at last follow-up in 97% of patients. The pivot-shift test was positive in 1% of patients. The mean subjective IKDC score was 84.5 ± 13.0 and 86.5% of patients were IKDC A or B. The proportions of patients with radiographic knee osteoarthritis at last follow-up was unchanged for the lateral tibio-femoral and patello-femoral compartments but increased by 9.7% to 21.2% for the medial tibio-femoral compartment. The re-rupture rate was 1.2% and the further surgical revision rate was 5.4%. Conclusion Anterior laxity at last follow-up was consistent with previous studies of revision ACL reconstruction. However, rotational stability and the re-rupture risk were improved. ALL stabilisation is among the techniques that deserve consideration as part of the therapeutic options for revision ACL reconstruction. Level of evidence IV, retrospective and prospective cohort study.

Le niveau d’endémie du virus de l’hépatite B varie selon les pays. L’étude, réalisée au 2e Régiment d’infanterie de Marine en 2010, avait pour objectifs d’estimer la proportion de sérologies du virus de l’hépatite B disponibles dans les dossiers médicaux des militaires nés hors métropole et d’estimer la prévalence du portage des Ac anti-HBc et de l’AgHBs selon la zone d’endémie du virus de l’hépatite B d’origine. Au total, plus de 85 % (152/178) des militaires du régiment nés hors métropole étaient originaires de zones de moyenne à forte endémie du virus de l’hépatite B. La couverture vaccinale contre le virus de l’hépatite B avant l’incorporation était faible (34,3 %). Une sérologie du virus de l’hépatite B était disponible dans le dossier médical pour près de la moitié des militaires et dans la moitié des cas cette sérologie provenait du Centre de transfusion sanguine des armées dans le cadre d’un don du sang. L’étude de ces sérologies révélait une prévalence élevée des anticorps anti-HBc et de l’AgHBs. Cinq militaires ont été vaccinés contre le virus de l’hépatite B alors qu’ils étaient porteurs de l’AgHBs. Ces résultats soulignent l’importance de sensibiliser les médecins des forces au dépistage du virus de l’hépatite B chez les militaires exposés à un risque élevé d’infection.

Graves' disease is a common autoimmune disorder that can be complicated, especially in smokers, by an orbitopathy which can sometimes jeopardize vision and result in functional sequelae affecting quality of life of these patients. Although the diagnosis of dysthyroid orbitopathy is usually obvious, clinical evaluation must specify the stage of progression (clinical activity score) and severity according to the European Group EUGOGO classification. At first, rapid restoration of the euthyroid state, smoking cessation and simple symptomatic ophthalmic treatment are suggested. In the case of severe or active orbitopathy, oral or intravenous corticosteroid therapy with or without orbital radiation therapy (and even emergency orbital surgery in the case of compressive optic neuropathy) should be implemented. Ultimately, orbital surgery (orbital decompression in cases of exophthalmos), oculomotor surgery (diplopia) or eyelid surgery (retraction) may be required depending on the severity of sequelae. A multidisciplinary approach involving ophthalmologist, endocrinologist and orbital surgeon should facilitate an overall diagnosis and treatment plan for these patients.

Background: We investigated the molecular mechanism of ß-lactam resistance in extended-spectrum ß-lactamase (ESBL)-producing Enterobacterial strains isolated in neonatal units of different hospitals in Anatnanarivo, Madagascar.Methods: Bacteria were identified by standard biochemical methods, disc diffusion antibiograms and Etest. Resistance genes were sought by PCR. Strains were characterized by Rep- PCR (Diversilab), plasmid analysis and rep-typing.Results: From April 2012 to March 2013, 29 ESBL-producing E. cloacae and 15 K. pneumoniae were isolated from blood culture (n = 32) or gastric samples (n = 12) performed at day 0 or 2 from 39/303 newborns suspected of early neonatal infection. These infants were treated with expanded spectrum cephalosporins, due to lack of carbapenems, leading to a high mortality rate (45 %). Isolates recovered were all, but 4, multidrug resistant, particularly to fluoroquinolones (FQ) except for 21 E. cloacae isolates. Isolates produced TEM-1 and CTX-M-15 ß-lactamases and their genes were located on several self- transferable plasmids of variable sizes sizes that could not be linked to a major plasmid incompatibility group. E. cloacae isolates belonged to 6 Rep-types among which two counted for 11 isolates each. The FQ resistant E. cloacae isolates belonged to one clone, whereas the FQ susceptible E. cloacae isolates belonged to four clones. The K. pneumoniae isolates belonged to 9 Rep-types among which one included five isolates.Conclusion: This study is the first molecular characterization of ESBL- producing isolates from neonatology units in Madagascar, a country with limited epidemiological data. It revealed an important multi-clonal dissemination of CTX-M-15- producing isolates reflecting both the high community carriage and the very early nosocomial contamination of the neonates.

Interest and knowledge on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in rotational control of the knee. This article describes a technique that allows for a combined anterior cruciate ligament (ACL) and anterolateral reconstruction, using an Iliotibial band (ITB) autograft. The graft is detached from the vastus lateralis from proximal to distal, at the center portion from ITB, preserving its distal insertion on the Gerdy tubercle. Its width is 1 cm for the distal part, used for the anterolateral ligament reconstruction, and 3 cm for the proximal part. An outside-in femoral tunnel is drilled respecting both the preferred favorable isometric femoral insertion site and the femoral ACL footprint. An ACL reconstruction combined with a lateral tenodesis with a continuous ITB graft respects the anatomical and isometric rules providing superior internal rotational control of the knee in comparison with a stand-alone ACL reconstruction.

Introduction L’orbitopathie dysthyroidienne (OD) debute par une phase inflammatoire, suivie d’une installation progressive de fibrose pour aboutir a une phase sequellaire. En cas d’OD moderee a severe en phase inflammatoire, une radiotherapie peut etre envisagee. En phase sequellaire, une decompression orbitaire chirurgicale peut s’averer necessaire s’il existe une gene fonctionnelle ou esthetique. Objectif Determiner l’eventuel impact de la radiotherapie orbitaire sur les resultats de la decompression orbitaire bilaterale en phase sequellaire. Le critere primaire de l’etude etait le gain obtenu sur l’exophtalmie apres chirurgie. Patients et methodes Il s’agit d’une etude observationnelle retrospective, exposes/non exposes selon que les patients avaient beneficie ou non d’une radiotherapie orbitaire avant une chirurgie de decompression. Trente-huit patients avaient recu une radiotherapie (RT+) et 98 n’en avaient pas recu (RT−), entre 1995 et 2016. Resultats Dans le groupe RT+ compare au groupe RT−, il y avait significativement plus d’hommes (29 % versus 12 %, p Conclusion Chez les patients ayant une OD, il n’y a pas d’effet deletere de la radiotherapie orbitaire sur les resultats de la decompression chirurgicale.

Introduction Lorsque une personne doit recevoir plusieurs vaccins vivants attenues, il est recommande de les administrer soit simultanement, soit en respectant un delai minimal de 28 jours entre les deux injections, en raison d’une possible interference negative sur la reponse immune a chacun de ces vaccins. L’objectif principal de cette etude etait de comparer la reponse humorale au vaccin amaril et au vaccin rougeole-oreillons-rubeole chez des enfants âges de 6 a 24 mois, vaccines avant un voyage en zone d’endemie amarile. Materiels et methodes Une etude retrospective cas-temoins multicentrique a ete menee dans 7 centres de vaccinations internationales de la region parisienne. Le statut immunologique d’enfants ayant recu le vaccin amaril et le vaccin rougeoleux, seul ou combine aux vaccins rubeole et oreillons, a un intervalle compris entre 1 et 27 jours (cas) a ete compare a celui d’enfants vaccines simultanement (temoins no 1) ou a plus de 27 jours d’intervalle (temoins no 2) contre la fievre jaune et la rougeole (la rubeole et les oreillons). Le critere d’evaluation principal etait le pourcentage d’enfants presentant une immunite protectrice vis-a-vis de la fievre jaune (titre neutralisant ≥ 10). Resultats Cent trente et un enfants ont ete inclus, 62 cas, 50 temoins no 1 et 19 temoins no 2. Parmi eux, 127 (96 %) avaient un titre protecteur d’anticorps antiamarils ; les quatre enfants non immunises vis-a-vis de la fievre jaune appartenaient tous au groupe temoins no 1. Conclusion Des etudes complementaires seraient necessaires pour confirmer ou infirmer ces resultats et modifier les recommandations actuelles, en supprimant l’intervalle minimum de 27 jours a respecter entre les vaccins rougeole-oreillons-rubeole et amaril. Nous pensons cependant qu’il est des a present possible de conseiller aux centres de vaccinations internationales de ne pas administrer ces deux vaccins le meme jour.

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Resume Propos Cette etude avait pour objectif de decrire les aspects epidemiologiques, cliniques et biologiques du liquide cephalorachidien (LCR) dans les meningites a Enterovirus . Methodes Il s’agissait d’une etude retrospective monocentrique conduite sur la periode 2004 a 2008, de toutes les meningites aseptiques dues a une infection a Enterovirus . Resultats Cinquante-neuf patients, d’âge moyen de 31,4 ans, ont ete inclus. La triade, fievre, cephalees, raideur de nuque etait presente chez 62 % des patients. Une hyperleucocytose sanguine a polynucleaires neutrophiles (PNN) etait presente chez 12 patients (20 %), la C-reactive proteine etait elevee dans 23 cas (39 %). Vingt-huit patients (47 %) avaient une predominance de PNN dans le LCR et neuf (15,2 %) presentaient une hypoglycorachie. Un traitement probabiliste anti-infectieux a ete initie chez 47 patients (80 %) pendant 3,2 jours en moyenne. Conclusion L’absence de specificite des signes cliniques et biologiques des meningites a Enterovirus rend necessaire la generalisation de la PCR a Enterovirus en temps reel pour limiter les hospitalisations et les traitements anti-infectieux inutiles. Les regles de decision aident a distinguer les meningites bacteriennes des meningites virales.

To calibrate the energy response of the ATLAS liquid argon calorimeter, an electronics calibration board has been designed; it delivers a signal whose shape is close to the calorimeter ionization current signal with amplitude up to 100 mA in 50 Ω with 16 bit dynamic range. The amplitude of this signal is designed to be uniform over all calorimeters channels, stable in time and with an integral linearity much better that the electronics readout. The various R&D phases and most of the difficulties met are discussed and illustrated by many measurements. The custom design circuits are described and the layout of the ATLAS calibration board presented. The procedure used to qualify the boards is explained and the performance obtained illustrated: a dynamic range up to 3 TeV in three energy scales with an integral linearity better than 0.1% in each of them, a response uniformity better than 0.2% and a stability better than 0.1%. The performance of the board is well within the ATLAS requirements. Finally, in situ measurements done on the ATLAS calorimeter are shown to validate these performances.

The “C2” unit in the Morichal Member of the Miocene Oficina Formation at the Sincor field (East Venezuela Basin) is characterised by a succession of superposed deltaic cycles which control vertical and horizontal reservoir connectivity. In order to model this reservoir in three dimensions, a workflow was developed which addressed a series of specific challenges. First, the deltaic nature of the succession required that both distributary channel and mouth bar sandbodies had to be modelled according to the defined sequence stratigraphic framework. Second, the relationship between distributary channels and mouth bars had to be honoured. A third issue was that individual distributary channel sandbodies were on occasion thicker than the cycle to which they belonged (i.e. they eroded down into the underlying cycle), and the relationship between mouth bar and channel sandbodies in adjacent sequences was therefore broken. Although conceptually simple from a geological viewpoint, this aspect proved particularly difficult during 3D modelling. This paper discusses the construction of the stratigraphic model, as well as that of the channel and mouth bar models. The workflow is based on existing stochastic approaches, arranged in nested steps dependent on the stratigraphic framework and on defined depositional processes in order to simulate reservoir distribution and partitioning. By integrating sedimentological observations and interpretations with existing modelling procedures, a reliable reservoir model can be built. The model is based on the observed sequence stratigraphic framework, and its infill takes into account the relationship between distributary channels and mouth bar deposits, derived from depositional processes. The model provides realistic distributions of the channel fills and mouth bar deposits at Sincor field using a multi-realisation scheme. Improved local vertical connectivity between individual sequences, caused by erosion of highstand mudstone seals and baffles, can effectively be simulated; this is of particular significance at Sincor where planned second-phase heavy oil recovery will depend on the use of steam-assisted gravity drainage.

Vector transmitted diseases are often a serious threat for child health, especially for children traveller in tropical regions. Few arthropod borne diseases are preventable by immunization or chimioprophylaxis. Prevention of most of them is based on personal protection against arthropod bites. The evidence of its efficacy has been established by the use of impregnated bed nets, impregnated clothes with permethrin or mosquito repellent which reduced significantly child malaria morbidity and mortality in endemic countries. These personal protective measures are able to minimize arthropod bites and prevent Chikungunya infection, dengue fever and Lyme disease. The choice of a repellent among the commercialised products need to be efficacy and safety evidence based. This article propose to raise this issue and to give pragmatic recommendations, with a focus to children below 30 months who are at a high toxicological risk. Severity of these diseases allowed to use potentially toxic repellents if misused.

Each year, half a million of children leave France to travel towards countries south or east of the European Union, sometimes in poor sanitary conditions. In order to propose essential or useful immunizations for these trips, the current synthesis will allow the practitioner to insure that the routine French immunization schedule has been followed, and to complete it if needed, to protect the child according to the epidemiological situation in the visited area, to try to reduce the limitations of the immunization of the traveler child. In case of emergency, or close departure, it may be useful to follow an accelerated schedule of the last minute, and, sometimes, to immunize traveler children with a chronic disease. Informations on Internet sites useful for the knowledge of current infectious risks in the destination country are also provided.

Purpose To determine the location and variability of the anterolateral ligament (ALL) femoral origin. Methods The ALL was dissected and examined in 52 embalmed specimens, and the femoral origin was isolated. The presence of a bony or soft-tissue attachment, the relation to the lateral collateral ligament, the average diameter of the proximal origin, and the specific location of the origin relative to the lateral femoral epicondyle were recorded. Results The ALL was present in all 52 specimens, with a mean diameter of 11.85 mm, and was consistently attached to bone in all specimens. The ALL consistently overlapped the lateral collateral ligament near its attachment, with the location of the origin directly on the lateral epicondyle in 12 specimens (23%), with a shared lateral femoral condyle and with the origin slightly posterior and proximal to the lateral epicondyle in 30 specimens (58%), and with the origin completely posterior and proximal to the lateral epicondyle in 10 specimens (19%). Conclusions The ALL showed a consistent bony origin overlapping the lateral collateral ligament in all specimens, with some variability in the femoral attachment, ranging from directly on the lateral epicondyle to posterior to the lateral epicondyle. Clinical Relevance The identification and description of the femoral origin of the ALL are crucial in understanding its role in the stability of the knee, as well as determining the appropriate position for the femoral origin placement in ALL reconstruction.