Search

The study of aerosols in the troposphere and in the stratosphere is of major importance both for climate and air quality studies. Among the numerous instruments available, aerosol particles counters provide the size distribution in diameter range from few hundreds of nm to few tens of μm. Most of them are very sensitive to the nature of aerosols, and this can result in significant biases in the retrieved size distribution. We describe here a new versatile optical particle/sizer counter (OPC) named LOAC (Light Optical Aerosol Counter), which is light and compact enough to perform measurements not only at the surface but under all kinds of balloons in the troposphere and in the stratosphere. LOAC is an original OPC performing observations at two scattering angles. The first one is around 12°, and is almost insensitive to the nature of the particles; the second one is around 60° and is strongly sensitive to the refractive index of the particles. By combining measurement at the two angles, it is possible to retrieve accurately the size distribution and to estimate the nature of the dominant particles (droplets, carbonaceous, salts and mineral particles) in several size classes. This topology is based on calibration charts obtained in the laboratory. Several campaigns of cross-comparison of LOAC with other particle counting instruments and remote sensing photometers have been conducted to validate both the size distribution derived by LOAC and the retrieved particle number density. The topology of the aerosols has been validated in well-defined conditions including urban pollution, desert dust episodes, fog, and cloud. Comparison with reference aerosol mass monitoring instruments also shows that the LOAC measurements can be successfully converted to mass concentrations. All these tests indicate that no bias is present in the LOAC measurements and in the corresponding data processing.

After 43 years of inactivity, the Calbuco volcano, which is located in the southern part of Chile, erupted on 22 April 2015. The space–time evolutions (distribution and transport) of its aerosol plume are investigated by combining satellite (CALIOP, IASI, OMPS), in situ aerosol counting (LOAC OPC) and lidar observations, and the MIMOSA advection model. The Calbuco aerosol plume reached the Indian Ocean 1 week after the eruption. Over the Reunion Island site (21° S, 55.5° E), the aerosol signal was unambiguously enhanced in comparison with background conditions, with a volcanic aerosol layer extending from 18 to 21 km during the May–July period. All the data reveal an increase by a factor of ∼ 2 in the SAOD (stratospheric aerosol optical depth) with respect to values observed before the eruption. The aerosol mass e-folding time is approximately 90 days, which is rather close to the value ( ∼ 80 days) reported for the Sarychev eruption. Microphysical measurements obtained before, during, and after the eruption reflecting the impact of the Calbuco eruption on the lower stratospheric aerosol content have been analyzed over the Reunion Island site. During the passage of the plume, the volcanic aerosol was characterized by an effective radius of 0.16 ± 0.02 µm with a unimodal size distribution for particles above 0.2 µm in diameter. Particle concentrations for sizes larger than 1 µm are too low to be properly detected by the LOAC OPC. The aerosol number concentration was ∼ 20 times higher that observed before and 1 year after the eruption. According to OMPS and lidar observations, a tendency toward conditions before the eruption was observed by April 2016. The volcanic aerosol plume is advected eastward in the Southern Hemisphere and its latitudinal extent is clearly bounded by the subtropical barrier and the polar vortex. The transient behavior of the aerosol layers observed above Reunion Island between May and July 2015 reflects an inhomogeneous spatio-temporal distribution of the plume, which is controlled by the localization of these dynamical barriers.

Les lésions artérielles de membres représentent désormais 10 % des blessés en situation de conflit. Leur survenue constitue un événement grave qui met en jeu le pronostic vital et fonctionnel. Leur prise en charge nécessite classiquement une exploration chirurgicale avec revascularisation en un temps. L’utilisation du shunt artériel temporaire rapportée à plusieurs reprises dans la littérature civile et militaire, représente une alternative séduisante conforme au principe de Damage control.

Objective:Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients’ post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis.Study design:Prospective case series.Setting:Tertiary care centre.Subjects and methods:We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases.Results:Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018).Conclusion:In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.

The hemangioma of the adrenal gland is an adrenal gland lesion rare, benign and usually asymptomatic. Discovered incidentally during an abdominal imaging study, it is part of incidentalomas. Imagery is the best to characterise these silent adrenal masses (computed tomography [CT], Magnetic Resonance Imaging [MRI]± Positron Emission Tomography [PET scan] with 18F-FDG). The main risks of the hemangioma are ignorance of malignancy, bleeding and abdominal mass syndrome. The analysis of the literature shows the importance of laparoscopy. A multidisciplinary discussion on this type of lesion appears indispensable both diagnostic and therapeutic.

Resume Objectifs Le syndrome chronique des loges (SCL) qui concerne une population jeune et sportive est souvent diagnostique tardivement. Son traitement est exclusivement chirurgical. Nous avons etudie les resultats postoperatoires des aponevrotomies pour SCL des membres inferieurs. Le but de ce travail etait de specifier, d’une part, la nature et les complications postoperatoires du traitement chirurgical realise. D’autre part, une evaluation du resultat fonctionnel a ete effectuee par les patients a distance de l’intervention. Methodes L’ensemble des patients operes de SCL des membres inferieurs de janvier 1985 a aout 2009 a ete etudie de maniere prospective. Le caractere uni- ou bilateral, la localisation topographique des loges musculaires concernees etaient releves. Par ailleurs, plus d’un an apres la chirurgie, le degre de satisfaction des patients etait etudie par un questionnaire d’autoevaluation du resultat fonctionnel. Resultats Deux cent trente-quatre patients ont ete inclus dans la cohorte de l’etude au cours de laquelle 236 interventions ont ete realisees. Une seule loge est atteinte dans 23,7 % des cas, concernant toujours la loge posterieure superficielle (56/236). L’atteinte de deux loges (anterieure et laterale) est retrouvee dans 38,1 % des cas (90/236). Une atteinte tricompartimentale est constatee dans 31,4 % des cas (74/236), touchant les loges posterieures superficielles et anterolaterales. Enfin, une lesion des quatre loges (anterolaterales, posterieures superficielles et posterieures profondes) est decrite dans 6,8 % des cas (16/236). Il n’a pas ete retrouve d’atteinte isolee de la loge posterieure profonde. Sept fois sur dix les deux jambes etaient atteintes. Le taux de reponse des patients au questionnaire etait de 65 %. Le taux declare de guerison etait de 68,4 %, et celui d’amelioration de 23,9 %. Le taux d’echec rapporte etait faible a 7,7 %. Conclusion Le diagnostic de SCL repose sur la mesure des pressions intramusculaires post-effort. Dans notre serie, l’aponevrotomie etait la regle. La technique chirurgicale etait standardisee. Les resultats semblent satisfaisants, de par le faible taux de complications postoperatoires, et le taux eleve de satisfaction des patients.

Resume L’occlusion tumorale du colon est une situation clinique frequente. Elle survient souvent chez des patients, qui ont un etat general altere et presentent un stade tumoral avance. L’amelioration du pronostic de ces patients passe par une levee d’occlusion rapide et la moins invasive possible. But de l’etude Analyser la prise en charge des occlusions colorectales aigues et evaluer l’efficacite et la morbimortalite des endoprotheses coliques. Materiel et methodes Etude retrospective monocentrique de janvier 2003 a mai 2008, qui porte sur les occlusions aigues du colon. La population, le cancer, le traitement et la morbimortalite ont ete analyses. Resultats Vingt-six patients âges en moyenne de 75 ans, dont le score de l ’ American Society of Anesthesiologists (ASA) etait superieur a 3 dans 63 % des cas. Il s’agissait d’un adenocarcinome colorectal sigmoidien dans 65 % des cas, de stade IV dans 73 % des cas. L’endoprothese colique a ete posee en premiere intention chez 94 % des patients. Un succes clinique etait observe dans 96 % des endoprotheses posees. La morbidite etait de 12 %, la mortalite de 4 %. Conclusion L’endoprothese colique est une option therapeutique efficace, dans la prise en charge des cancers coliques occlusifs. Elle devrait etre envisagee en premiere intention, permettant de realiser un bilan d’extension complet et un traitement carcinologique.

Les tumeurs desmoides L. Montagliani, V. Duverger Les tumeurs desmoides sont des tumeurs rares caracterisees par une malignite locale avec une grande tendance a recidiver. Ces tumeurs se situent dans la paroi abdominale, dans l’abdomen, ou en extra-abdominal. Bien que la plupart des cas soient sporadiques, un traumatisme, des facteurs hormonaux et des facteurs genetiques sont les principaux facteurs etiologiques retrouves. Les circonstances de decouverte sont tres variees et leur expression clinique est souvent aspecifique. Le traitement a visee curative est chirurgical, meme s’il n’empeche pas le risque de recidive, qui reste eleve. Cependant ce traitement n’est pas strictement codifie et plusieurs traitements complementaires ont ete proposes avec des resultats utiles a connaitre.

In the companion paper (Renard et al., 2015), we have described and evaluated a new versatile optical particle counter/sizer named LOAC (Light Optical Aerosol Counter) based on scattering measurements at angles of 12 and 60° that allows some topology identification of particles (droplets, carbonaceous, salts, and mineral dust) in addition to size segregated counting in a large diameter range from 0.2 up to possibly more than 100 μm depending on sampling conditions. Its capabilities overpass those of preceding optical particle counters (OPCs) allowing the characterization of all kind of aerosols from submicronic-sized absorbing carbonaceous particles in polluted air to very coarse particles (> 10–20 μm in diameter) in desert dust plumes or fog and clouds. LOAC's light and compact design allows measurements under all kinds of balloons, on-board unmanned aerial vehicles (UAV) and at ground level. We illustrate here the first LOAC airborne results obtained from an unmanned aerial vehicle (UAV) and a variety of scientific balloons. The UAV was deployed in a peri-urban environment near Bordeaux in France. Balloon operations include (i) tethered balloons deployed in urban environments in Vienna (Austria) and Paris (France), (ii) pressurized balloons drifting in the lower troposphere over the western Mediterranean (during the Chemistry-Aerosol Mediterranean Experiment – ChArMEx campaigns), (iii) meteorological sounding balloons launched in the western Mediterranean region (ChArMEx) and from Aire-sur-l'Adour in south-western France (VOLTAIRE-LOAC campaign). More focus is put on measurements performed in the Mediterranean during (ChArMEx) and especially during African dust transport events to illustrate the original capability of balloon-borne LOAC to monitor in situ coarse mineral dust particles. In particular, LOAC has detected unexpected large particles in desert sand plumes.

The study of aerosols in the troposphere and in the stratosphere is of major importance both for climate and air quality studies. Among the numerous instruments available, aerosol particles counters provide the size distribution in diameter range from few hundreds of nm to few tens of μm. Most of them are very sensitive to the nature of aerosols, and this can result in significant biases in the retrieved size distribution. We describe here a new versatile optical particle/sizer counter (OPC) named LOAC (Light Optical Aerosols Counter), which is light and compact enough to perform measurements not only at the surface but under all kinds of balloons in the troposphere and in the stratosphere. LOAC is an original OPC performing observations at two scattering angles. The first one is around 12°, and is almost insensitive to the nature of the particles; the second one is around 60° and is strongly sensitive to the refractive index of the particles. By combining measurement at the two angles, it is possible to retrieve accurately the size distribution and to estimate the nature of the dominant particles (droplets, carbonaceous, salts and mineral particles) in several size classes. This speciation is based on calibration charts obtained in the laboratory. Several campaigns of cross-comparison of LOAC with other particle counting instruments and remote sensing photometers have been conducted to validate both the size distribution derived by LOAC and the retrieved particle number density. The speciation of the aerosols has been validated in well-defined conditions including urban pollution, desert dust episodes, fog, and cloud. Comparison with reference aerosol mass monitoring instruments also shows that the LOAC measurements can be successfully converted to mass concentrations. All these tests indicate that no bias is present in the LOAC measurements and in the corresponding data processing.

In a companion (Part 1) paper (Renard et al., 2015), we have described and evaluated a new versatile optical particle counter/sizer named LOAC (Light Optical Aerosols Counter) based on scattering measurements at angles of 12 and 60°. that allows some speciation of particles (droplets, carbonaceous, salts, and mineral dust) in addition to size segregated counting in a large diameter range from 0.2 up to possibly more than 100 μm depending on sampling conditions. Its capabilities overwhelm those of preceding optical particle counters (OPCs) allowing the characterization of all kind of aerosols from submicronic-sized absorbing carbonaceous particles in polluted air to very coarse particles (> 10–20 μm in diameter) in desert dust plumes or fog and clouds. LOAC light and compact design allows measurements under all kinds of balloons, on-board unmanned aerial vehicles (UAV) and at ground level. We illustrate here the first LOAC airborne results obtained from an unmanned aerial vehicle (UAV) and a variety of scientific balloons. The UAV was deployed in a peri-urban environment near Bordeaux in France. Balloon operations include (i) tethered balloons deployed in urban environments in Wien (Austria) and Paris (France), (ii) pressurized balloons drifting in the lower troposphere over the western Mediterranean (during the Chemistry-Aerosol Mediterranean Experiment – ChArMEx campaigns), (iii) meteorological sounding balloons launched in the western Mediterranean region (ChArMEx) and from Aire-sur-l'Adour in south-western France (VOLTAIRE-LOAC campaign). More focus is put on measurements performed in the Mediterranean during (ChArMEx) and especially during African dust transport events to illustrate the original capability of balloon-borne LOAC to monitor in situ coarse mineral dust particles. In particular, LOAC has detected unexpected large particles in desert sand plumes.

Resume But de l'etude Preciser les modalites diagnostiques et les traitements immediats et au long cours des thromboses de la veine mesenterique superieure. Patients et methodes Etude bicentrique retrospective de 1997 a 2004. Tous les parametres cliniques, paracliniques utiles au diagnostic ainsi que l'attitude therapeutique ont ete releves. Resultats Neuf patients (tous des hommes), d'âge moyen 55 ans ont ete inclus. Une douleur abdominale (100 %), des vomissements (44 %), et des troubles du transit (44 %) ont ete les principaux symptomes. Il existait un passe personnel et/ou familial de thrombose veineuse chez 67 % des patients. Une cause genetique de thrombophilie a ete constatee dans 78 % des cas. Le diagnostic a ete pose par une tomodensitometrie abdominale dans huit cas sur neuf avec un retard de huit jours en moyenne. Un traitement medical a ete suffisant dans 33 % des cas, les autres patients ayant ete operes pour un infarctus du grele traite par resection dans tous les cas avec une seule anastomose immediate. Toutes les stomies ont ete fermees secondairement. La mortalite a ete nulle. Conclusion Le diagnostic de thrombose veineuse mesenterique est souvent retarde et repose sur le scanner avec injection. Le pronostic est globalement bon mais depend en partie de la precocite du traitement anticoagulant. En cas d'intervention, le chirurgien doit etre econome dans les resections et ne doit pas hesiter a realiser des stomies. Une thrombophilie est le plus souvent presente et un traitement anticoagulant prolonge voire definitif est souhaitable.

In this report we show that mithramycin considerably increases the direct cytotoxic effect of tumour necrosis factor (TNF) on tumour cells in vitro. Sensitisation to TNF-induced apoptosis was prevented by the broad caspase inhibitor zVAD-fmk, whereas overexpression of Bcl-2 had no effect. Mithramycin also potentiated cell death induced by Fas agonistic antibodies. In contrast, mithramycin reduced the percentage of cells undergoing apoptosis due to factor withdrawal. TNF-induced activation of NF-kappaB (NF-kappaB)-dependent gene expression was not modulated by mithramycin treatment. Concomitantly with the increased sensitivity, the protein level of the short-spliced cFLIP variant was downregulated. These results indicate that mithramycin enhances TNF-induced cell death in an NF-kappaB-independent manner, and suggest that the Fas-associated death domain protein plays a crucial role in the TNF-sensitising effect of mithramycin.

Resume Les migrations distales d’endoprotheses biliopancreatiques sont des evenements rares, generalement benins, mais qui peuvent toutefois conduire a des complications graves comme la perforation digestive. Nous rapportons le cas d’un patient ayant presente une double perforation sigmoidienne suite a la migration distale d’une endoprothese biliaire mise en place dans le cadre d’une tumeur de la tete du pancreas.

Migration of pancreatico-biliary stents is a rare event, usually benign, but which can lead to severe complications such as digestive tube perforation. We report the case of a patient with double sigmoid perforation due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.

The aim of this study was to report two cases of rupture of the right hemidiaphragm with intra-thoracic liver hernia, associated with a traumatic aortic disruption. These two lesions followed traffic accidents, and were both treated separately. Both patients had a long-term favourable progression. Association of these two lesions is particularly rare: fewer than 50 cases have been previously described in an extensive review of the literature. CT-scan seems to be particularly efficient in diagnosis, even if less efficient than other more specific explorations. The order of surgical management is guided by the physical examination, and especially by abdominal emergency.

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.

Objective To evaluate the activity of visceral surgeons assigned to the Medical Treatment Facility (MTF) (role 3) in Kabul International Airport (KAIA) and identify the skills and qualifications required by these specialists. Patients and methods Between July 2009 and December 2010, all the patients operated by the visceral surgeons were eligible for inclusion in this study. They were International Security and Assistance Force (ISAF), Afghan National Security Forces (ANSF) soldiers, non-afghan civilians personnel and local nationals (LNs). They sustained war-related injuries, non-war related trauma emergencies, non-trauma related emergencies or had elective surgical care. The mechanisms and types of injuries, the affected organs and the surgical procedures were collected. Results Over the period of study, the visceral surgeons treated 261 over 971 patients (26.9%) achieving a total of 438 surgical procedures. Thirty one percent of these procedures were war-related, 26% non-war related, 24.2% non-trauma related emergencies and 18.1% elective surgery. Non-trauma related emergencies and elective surgery required the same skills as in civilian practice. War-related injuries and non-war related trauma emergencies were more challenging. Combined injuries represented 56% of the cases requiring damage control resuscitation procedures and/or treatment of severe burns. Life-threatening thoracic or vascular injuries (30%) required life-saving emergency surgical procedures. Conclusion A visceral surgeon in a role 3 MTF should master a wide range of skills and expertise to be able to deal with many complex situations, in particular life-threatening situations such as thoracic and vascular wounds. A comprehensive surgical training programme for surgeons in abroad deployment (Advance Course for Deployment Surgery – CACHIRMEX) has been designed and settled up in 2007 to provide these necessary skills. The feedback obtained from each previous deployment demonstrates that the advanced course for deployment surgery provides visceral surgeons the necessary skills required to deliver surgical healthcare in a role 3 MTF. However, a regular assessment of this programme is mandatory to ensure that this training stays appropriate and contributes to better outcomes and a decreased mortality rate.

Giant hydatid cyst located in the retroperitoneal space is rare. The purpose of this report is to present a case cured by surgery in an adult traveller.In August 2009, a 67-year-old female who traveled frequently to Lebanon was admitted for assessment of a giant retroperitoneal hydatid cyst discovered coincidentally following palpation of an abdominal mass in 1997. From 1966 to 1975, the patient had undergone several surgical procedures for pulmonary and hepatic hydatidosis, complicated by vomica and anaphylactic shock. In 1997, computed tomography showed that the retroperitoneal cyst measured 100 mm at the widest point. At that time, the patient refused to undergo further surgery and was treated medically using albendazole initially in association with praziquantel. In 2009, the cyst had expanded to 180 mm at the widest point and the patient finally consented to perikystectomy. Excision was total and recovery was uneventful. Histology examination confirmed the viability of the cyst. Follow-up examination at 12 months indicated no relapse.The retroperitoneal space is a rare location for hydatidosis. Occurrence in this location is generally primary. In case of discovery of a liquid-filled retroperitoneal mass, a history of travel to an endemic area for hydatid disease should be elicited. Diagnosis relies on radiological findings and positive serology. Since retroperitoneal cysts are often giant, they respond poorly to medical treatment. Similarly radiological treatment is difficult due to retroperitoneal location. Surgery, preferably perikystectomy, is the treatment of choice.

Diagnosis of chronic compartment syndrome of the lower leg, which occurs in a young and athletic population, is often delayed. We studied postoperative outcomes after fasciotomy in patients with compartment syndrome in order to identify specific postoperative complications. Long-term functional outcomes were also evaluated.All patients with a diagnosis of chronic exercise-related compartment syndrome of the lower leg who underwent surgery from January 1985 to August 2009 were studied prospectively. The type of compartment and whether surgery was uni or bilateral was recorded. One year after surgery, patients completed a questionnaire to evaluate their functional outcome.Two hundred and thirty-six compartment procedures were performed in 234 patients. Only one compartment (constantly the superficial posterior compartment) was treated in 56/236 (23.7%) procedures. Two compartments (anterior and lateral) were involved in 90/236 procedures (38.1%). Three compartments (anterolateral and superficial posterior) were noted in 74/236 procedures (31.4%) and four compartments (anterolateral and superficial and deep posterior) were described in 6.8%. Involvement of the deep posterior compartment was always associated with another compartment. Surgery was bilateral in 70% of patients. The questionnaire response rate was 65%. The success rate of fasciotomy was 68.4% and a significant improvement was reported by 23.9% of responders; outcome was unsatisfactory for 7.7%.The diagnostic criteria used to confirm chronic exercise-related compartment syndrome of the lower leg were based on the compartment pressure measurement after exercise. In this study, all patients underwent fasciotomy. The surgical technique was standardized. Outcomes have been satisfactory with few surgical complications.

Resume Les auteurs rapportent une observation de necrose ischemique de l’œsophage liee a une hypothermie majeure. Ils rappellent les etiologies habituellement responsables de « l’œsophage noir », soulignent la place importante de l’origine ischemique et evoquent ensuite la prise en charge multidisciplinaire de cette pathologie exceptionnelle.

The hemangioma of the adrenal gland is an adrenal gland lesion rare, benign and usually asymptomatic. Discovered incidentally during an abdominal imaging study, it is part of incidentalomas. Imagery is the best to characterise these silent adrenal masses (computed tomography [CT], Magnetic Resonance Imaging [MRI]± Positron Emission Tomography [PET scan] with 18F-FDG). The main risks of the hemangioma are ignorance of malignancy, bleeding and abdominal mass syndrome. The analysis of the literature shows the importance of laparoscopy. A multidisciplinary discussion on this type of lesion appears indispensable both diagnostic and therapeutic.

Obstruction due to colorectal cancer is a common occurrence. It often arises in patients in poor general condition with malnutrition and advanced tumor stage. Prognosis can be improved by prompt resolution of obstruction through a mininimally invasive approach.To analyze the management of cases of acute colorectal obstruction and evaluate the efficacity and morbidity/mortality associated with the use of endocolic stent prostheses.This retrospective study at a single center evaluated patients presenting with acute colorectal obstruction between January 2003 and May 2008, assessing the patient sample, cancer characteristics, treatment, and morbidity/mortality.The mean age of the 26 patients was 75 years; ASA Class was greater than III in 63% of cases, The colorectal cancer was located in the sigmoid in 65% of cases and was a Stage IV tumor in 73% of cases. Placement of an endocolic stent was the primary intervention in 94% of patients. Morbidity was 12% and mortality was 4%.Colonic stenting is an effective therapeutic option in the elderly with painful symptoms of obstruction and should be the initial approach.

Desmoid tumors are a rare form of malignancy with a great propensity for local extension and recurrence. They typically occur in the abdominal wall or within the abdomen but also may occur extra-abdominally. Most cases are sporadic but traumatic, hormonal, and genetic etiologies have been implicated. The only curative treatment is wide surgical excision, but the risk of local recurrence is high. Several adjuvant or complementary treatments have been proposed and the results show promise; the authors review all these therapies.

Bourneville tuberous sclerosis is a phacomatosis characterized by skin, neurological and ophthalmological lesions. At first, seizure can reveal cerebral lesions, but other causes may be suspected. We report a case of a Bourneville tuberous sclerosis in a 41-year-old-man with hypoglycemia leading to seizures, resulting from an insulinoma.

To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis.Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis.Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died.Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.

The aim of this study was to report two cases of rupture of the right hemidiaphragm with intra-thoracic liver hernia, associated with a traumatic aortic disruption. These two lesions followed traffic accidents, and were both treated separately. Both patients had a long-term favourable progression. Association of these two lesions is particularly rare: fewer than 50 cases have been previously described in an extensive review of the literature. CT-scan seems to be particularly efficient in diagnosis, even if less efficient than other more specific explorations. The order of surgical management is guided by the physical examination, and especially by abdominal emergency.

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.

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.

Subadventitial cyst of the popliteal artery is a well known entity. We report a new case and the diagnostic and therapeutic advantages of noninvasive explorations. Transcutaneous duplex-scan provided diagnosis and showed cystic formations in contact with a segmentary occlusion of the popliteal artery. Magnetic resonance imaging (MRI) evidenced communication between the cysts and the articular capsule of the knee joint. Surgical exeresis confirmed the communication with the synovial fluid. This observation demonstrated: i) the contribution of duplex-scan for the diagnosis of adventitial cysts and arterial consequences; ii) the contribution of MRI in identifying communication with the synovial fluid; iii) the presence of arterial wall lesions (necrosis of the media) would favor no conservative treatment.

The two-hundredth anniversary of the creation of the School of Health in Strasbourg was celebrated on December 3rd, 1994. Early in its history, the School also trained officers in the military health service. The close relationship between civilians and the military at the School led to the creation of the Imperial School of the Military Health Service which opened its doors in Strasbourg in 1856. Teaching was unfortunately halted by the war in 1870 and the school did not reopen until it was transfered to Lyon in 1888 where the former organization of the Imperial School of Strasbourg was maintained. "Si la faculté de Strasbourg a emprunté plus d'un de ses professeurs à la médecine militaire, combien celle-ci, en même temps, ne lui a-t-elle pas fourni de disciples?"

From the study of one case of non secreting paraganglioma of the organ of Zuckerkandl, the authors have surveyed the existing literature gathering 95 cases from 1902 to 1992. It is an exceptional tumor of the paraganglioma and it often a secreting one. When it is not it looks like a malignant retroperitoneal tumor. The surgical resection is often performed without the operating diagnosis. Asserting the malignancy of these tumors only depends on the presents of metastasis appearing lately. There fore a long continued control of the patients who have been operated upon is a must all the more as 30% of the paraganglioma of Zuckerkandl prove to be malignants.

Study of a new series of 52 cases of hysterorrhexis observed at Oddiene, county town in the North-West of Ivory Coast, underlines the pejorative impact of isolation and of the insufficiency of monitoring of the pregnancies in remote areas. The paper details causes and consequences of such an obstetrical catastrophic event, and reports some conclusions of the surgical treatment in which suturing is the most frequent act.