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The profession of pathologist exposes to various risks, notably infectious, physical and chemical. The objective of this study was to make an inventory of these occupational risks to which pathologists are subjected and to evaluate the pathologies that they presented. A particular attention was given to microscopic and screen work as they can induce musculoskeletal or ophthalmic disorders, and stress-related psychological disorders.An anonymous online questionnaire containing 54 questions had been sent by mail to pathologists via the French Society of Pathology and the Syndicate of French Pathologists.Five hundred and twelve pathologists responded to the survey. Thirty-eight percent reported musculoskeletal disorders in the last 6 months. Visual disturbances concerned 73.4% of respondents. In the last 12 months, 33.3% of pathologists had been injured or had had mucosal projections during macroscopic or autopsy specimens. The frequency of infectious diseases was low (6.2%) as well as that of cancers (3.9%). Psychological disorders such as depression or burnout were reported by 16.7% of respondents. Pathologists seemed happy at work and had a good overall lifestyle. Few doctors had medical follow-up and few had benefited from ergonomic advice and training on the risks of chemicals.The results of this study showed the interest of a medical surveillance adapted to the pathologies presented by the pathologists. Educational and preventive measures should be introduced early in the career, focusing on ergonomics and learning about chemical and biological hazards.

Professional accidents and occupational diseases are a major subject for the workers and the social welfare policy. The workers in forest are particularly exposed to accidents. This is a sector that will be essential for dressing the ecological challenges of the xxith century, and could generate many new jobs. The present article proposes a statistical analysis of the accidents and the diseases witch affect the forest workers from the data of the CCMSA, in order to explore potential ways for improving their working conditions and safety.

Occupational blood and body fluids exposure. Occupational blood and body fluids exposure (BBFE) is a serious daily risk to healthcare workers (HCW) wherever they work (i.e. hospital, nursing home or private care). The knowledge of BBFE epidemiology over these 3 sectors of care allows HCF to be aware of BBFE circumstances and can enhance prevention in order to improve overall BBFE prevention. The improvement for compliance with standard precautions and protocols to prevent exposure to BBFE and the increase of safety device disposal use are the main keys of HCW safety.Accidents exposant au sang en france Les professionnels de santé, quel que soit leur lieu d’activité (hôpital, établissement médico-social et ville), sont, au quotidien, susceptibles d’être victimes d’accidents exposant au sang. La connaissance des données épidémiologiques de ces accidents dans les trois secteurs de l’offre de soins permet aux professionnels de santé d’être conscients des circonstances de ces accidents pour mettre en place les mesures de prévention ad hoc. L’amélioration du respecter des précautions standard et des protocoles pour prévenir l’exposition au sang et aux liquides biologiques ainsi que la mise à disposition croissante des dispositifs médicaux de sécurité sont les principales clefs de la sécurité d’exercice des professionnels.

How to recognize and report a work accident or an occupational disease. The notion of occupational risk has been introduced into French regulation in the late nineteenth century. Since then, French workers have the opportunity to receive specific benefits for accidents and diseases attributable to their professional activity. In 2014, 4% of employees affiliated to the general social security scheme were affected by a work accident or an occupational disease. However these figures are underestimated because of under-declarations. This lack of declarations relates both to employers, victims and health professionals. Concerning physicians, inadequacy of information on the modalities and possibilities of declarations is often involved. The author aims to provide a synthesis and practical tools for physicians, so they can provide the best support and information to their patients. The procedures of recognition and declaration are presented according to the different mandatory insurance schemes.Comment reconnaître et déclarer un accident du travail ou une maladie professionnelle. La notion de risque professionnel a été introduite dans le corpus législatif français à la fin du xixe siècle. Depuis, les travailleurs français ont la possibilité de bénéficier de prestations spécifiques pour les accidents et les maladies imputables à leur activité professionnelle. Ainsi, en 2014, 4 % des salariés affiliés au régime général de la Sécurité sociale étaient concernés par un accident du travail ou une maladie professionnelle. Cependant ces chiffres restent sous-estimés du fait des sous-déclarations. En pratique, chacun des acteurs du processus de déclaration, c’est-à-dire les employeurs, les victimes et les professionnels de santé, est en partie responsable de ce défaut de déclarations. Concernant les médecins, c’est souvent le manque d’informations sur les modalités et les possibilités de déclarations qui est en cause. L’objectif de cet article est de fournir une synthèse et des outils pratiques aux médecins, afin qu’ils puissent informer et accompagner au mieux leurs patients dans leurs démarches et ainsi participer activement au processus de déclaration. Les modalités de reconnaissance et de déclaration sont présentées en fonction des différents régimes d’assurance obligatoire auxquels peuvent être affiliés les patients.

Traditional gold washing traumatism during traditional gold panningfalls within the scope of occupational accidents, which are common pathologies in developing countries such as Mali.A 1-year prospective study from November 2014 to November 2015 on the cases of traumatism during traditional gold washing (TOT) admitted to the emergency room(ER) of the University Hospital Gabriel Touré during the study period. Data were collected from outpatient visit records and medical charts. Data were collected on the survey sheets and analyzed with Epi-info version 7.1.1.0.fr software. Data entry was made with Windows 7 software.During the study period, 21,400 patients were admitted to the ER, of whom 445 patients were victims of traumatism, a frequency of 2.08% of all outpatient visits in the ER. The age group 21-40 years old was the most represented with 64.94% of the cases. The male gender was predominant with 77.08% of the cases with a sex ratio of 3.36. Mine landslides were the most common causality in 65.39% of the cases. Dorsal spine involvement was the most common with 41.80% of cases. Medullary vertebral fracture was the most frequent diagnosis with 43.82% of cases. In total, 79.55% of patients received medical treatment. Patients or were transferred to neurosurgery department in 58.20% of cases.Traumatism during traditional gold panning is common. Lesions most often fit in a context of polytraumatism. The rapidity of the diagnosis and management are crucial to the prognosis of the disease.Les traumatismes d'orpaillage traditionnel entrent dans le cadre des accidents de travail survenu au cours de l'orpaillage traditionnel fréquemment rencontrés dans certains pays en voie de développement comme le Mali. Nous avons entrepris cette étude dans leEtude prospective sur un an, de novembre 2014 à novembre 2015 portant sur les cas des traumatismes au cours de l'orpaillage traditionnel (TOT) admis au service d'accueil et des urgences (SAU) pendant la période d'étude. Les données étaient recueillies à partir des registres de consultation, des dossiers médicaux. Les données ont été collectées sur les fiches d'enquête et analysées à partir du logiciel Epi-info version 7.1.1.0.fr. La saisie a été faite à partir du logiciel Windows 7.Durant la période d'étude, 21400 patients ont été admis au SAU, parmi lesquels 445 patients étaient victimes des traumatismes soit une fréquence de 2,08% de l'ensemble des consultations du service. La tranche d'âge de 21–40 ans a été la plus représentée avec 64,94% des cas. Le sexe masculin a été prédominant soit 77,08% des cas avec un sex ratio de 3,36 en faveur des hommes. Les éboulements de mine ont été l'étiologie la plus fréquente avec 65,39% des cas. L'atteinte dorsale était la plus fréquente avec 41,80% des cas. La fracture vertébro médullaire a été le diagnostic le plus fréquent avec 43,82% des cas. La majorité des patients soit 79,55% des cas ont reçu un traitement médical. La plupart des patients soit 58,20% des cas ont été transférés en neurochirurgie.Les traumatismes survenus au cours de l'orpaillage traditionnel sont fréquents. Les lésions s'intègrent le plus souvent dans un contexte de poly-traumatisme. La rapidité du diagnostic et de la prise en charge sont déterminants au pronostic de la maladie.

The accidental loss of fingertip soft tissues, which may expose tendons and bones, is a common injury in emergency departments. If these lesions are poorly treated, they can impair fine motor skills and tactile sensitivity of the fingertips. The study was conducted on 30 patients (24 males and 6 females) with 32 soft tissue defects of the fingertip treated in emergency plastic surgery with local pedicled flap at the Plastic Surgery Department of Saint Paul Hospital Hanoi from 01/2016 to 06/2017. The most common cause of injury (21/30) was occupational accidents. At the time of the accident, 12 patients did not have personal protective equipment (PPE). Among 18 patients who had one, eight had incomplete equipment. Of 32 implanted skin flaps, 31 survived completely without necrosis or infection, only one being affected by epidermolysis. Postoperative evaluation showed excellent motor skills for 31/32 fingers and a sensitivity restoration at S4 level for 27/32. Workplace accident is the main cause of fingers soft tissue defects. Covering the fingers soft tissue defects with local pedicled flap in emergency preserves the fine motor function and the delicated tactile sensation of the fingers.Une étude sur les pertes de substance accidentelles de la pulpe des doigts et leur recouvrement par lambeaux locaux a été réalisée dans le service de chirurgie reconstructive de l'hôpital Saint Paul de Hanoï de janvier 2016 à juin 2017. Elle a concerné 30 patients, 24 hommes et 6 femmes. La cause la plus fréquente était l'accident de travail, soit 21/30 cas. Au moment de l'accident, 12 patients ne disposaient pas d'équipement de protection individuelle (EPI). Sur les 18 patients qui en possédaient, 8 avaient un équipement incomplet. Sur 32 lambeaux mis en place, 31 ont survécu complètement sans nécrose, ni infection, et un a subi une épidermolyse. Trente et un des 32 doigts opérés ont conservé une fonction motrice de bonne qualité et 27 ont récupéré une sensibilité de niveau S4. Le traitement en urgence des pertes de substance de la pulpe des doigts par des lambeaux locaux permet de préserver la fonction motrice fine et la sensibilité des pulpes des doigts.

Occupational physicians and insurance physicians each have their own roles in managing the consequences of work accidents and their interaction is pivotal in the administrative and clinical process of return to work. We wanted to analyse the barriers and facilitators of this collaboration in Belgium.A qualitative study was conducted based on individual interviews of a sample of insurance physicians and occupational physicians working in French-speaking Belgium. This sample was selected to represent all insurance companies and most prevention and protection services operating on the territory. The interview scheme was designed to explore the various dimensions of the RDIC model (Resource Dependence Institutional Collaboration) of collaboration between professionals.This study highlighted certain obstacles to collaboration, related to the mutual perception of the 2 professions, ignorance of the other profession’s work context, lack of independent resources blocking the willingness to cooperate (sufficient time, fees). Some facilitating factors were also identified : occupational physicians’ willingness to cooperate, a positive attitude towards the ability to cooperate, as well as proposals for immediate improvement of some factors. Collaboration between these 2 professions has rarely been studied and the results of the present study provide tracks for improvement that can be applied in the short or medium term to enable those two categories of physicians to be better organized and more efficient in managing disability consequences of work accidents.

Les traumatismes du rachis représentent une des lésions les plus fréquemment observées, chez les victimes d’accidents de circulation, d’accident de sportifs, domestique et du travail. Il s’agissait d’une étude rétrospective de 3 ans portant sur 139 cas de traumatismes du rachis hospitalisés et pris en charge dans le service de neurochirurgie du CHUJRA Madagascar. A travers cette étude, 25,17% des traumatisés étaient entre 21 et 30 ans avec une nette prédominance masculine de 69,78% (sexe ratio 2,3). L’étiologie était dominéepar la chute dans 33,09% des cas avec des facteurs de risque dont prise d’alcool (8,63%). Le traumatisme entrait dans le cadre d’un polytraumatisme dont un traumatisme crânien dans 34,63%. Les patients étaient admis dans le service 1 à 5h après le traumatisme dans 31,65% en utilisant comme moyen de transport une voiture personnelle dans 36,69%. Pendant l’hospitalisation 20 patients ont signé une décharge et 6,34% des patients sont décédés. Les traumatismes du rachis posent un problème de santé publique avec une prise en charge lourde surtout pour les patients déficitaires à vie. Devant tout traumatisme du rachis, il faut rechercher systématiquement une lésion crânienne.

A patient was hospitalised for two years for initial and follow-up care after a serious workplace accident. After a stay in intensive care and hospitalisation for reconstructive surgery, the care continued in a rehabilitation unit. In this specific environment, the commitment, dynamics and creativity of the caregivers helped to establish a climate of compassionate care in which the patient was able to learn how to live again.

Les amputations digitales sont des lésions fréquentes, la majorité étant provoquée par des accidents de travail. Les techniques microchirurgicales représentent une alternative pour réparer ces amputations. L'objectif de ce travail est de rapporter notre expérience dans la replantation digitale à travers l'étude de 18 cas. Nous avons mené une étude rétrospective, étalée entre Juin 2013 et Janvier 2015, incluant 14 patients présentant une amputation totale ou subtotale des doigts. Nous avons inclus dans notre série toutes les replantations unidigitales et multidigitales réalisées en aval de l'insertion distale du tendon fléchisseur superficiel ainsi que les replantations digitales réalisées en amont de l'insertion distale du tendon fléchisseur superficiel. Nous avons opéré ces patients selon le procédé classique de réimplantation digitale. Cinq replantations ont été secondairement régularisées. Parmi les 18 replantations, huit replantions digitales ont favorablement évolué puisque la replantation a permis de restituer un secteur complet de mobilité passive et active du doigt opéré sans chirurgie de reprise et sans complication secondaire précoce et tardive. Dans notre étude nous avons noté des résultats satisfaisants, malgré les conditions difficiles notamment le conditionnement initial du doigt amputé, et le délai de prise en charge retardé. Le développement et la maîtrise de la microchirurgie a permis de changer le pronostic de ces amputations à retentissement fonctionnel et psychologique difficile, les résultats de notre série sont encourageants pour a mise en place d'un service SOS main au Maroc.

Olfactory loss due to head trauma is a frequent finding. It is attributed to the tearing or severing of the olfactory fibers at the cribriform plate. In contrast, posttraumatic gustatory loss is observed and reported rarely and the underlying mechanism is less understood. Here we present a case of a concomitant post-traumatic anosmia and ageusia. Imaging showed a considerable frontobasal brain damage and it is speculated that the gustatory impairment is due to a central injury of the secondary taste cortex. Based on this observation, we believe that this clinical presentation might be much more frequent than previously reported.

The use of illicit drug can affect workplace absenteeism, accidents, job turnover and worker productivity. The magnitude of the cost borne by employers has not yet been calculated.Assessing the perception corporate directors in Belgium on illicit drug use and costs that the company has to bear because of this consumption.An online survey on alcohol and other drugs was conducted in 2005 with 216 employers in Belgium, based on a stratified random sample of companies with 50 employees or more. Data on the costs related to illicit drugs incurred by the company were collected from 17 companies in the sample. The survey results were supplemented by data from a literature review.Employers have little data on the impact of illicit drugs on the company. A very small sample of companies has given us enough information for a first estimate of the cost incurred by the use of illegal substances in the workplace. Their estimates are still very close to the estimates found in the few articles from the literature. Reduced productivity is seen as the most important cost.The productivity of employees who use drugs was estimated reduced by 30%. Employers perceive the reduced productivity of drug users as the most important cost, rather than absenteeism, accidents and staff turnover.

This is a prospective study conducted in December 2012 among 128 at the Nianankoro Fomba Hospital in Segou in order to assess their knowledge and practices on Blood Exposure Accidents (BEA). The average age of caregivers was 35.4 ± 9 years (range: 22-59 years). The nurses were predominant with 37.5%. The definition of BEA was mastered by 43.8%. The main transmissible infectious agents (HIV, HBV and HCV) were ignored by 76.6%. Questioning revealed that during the treatment, 78.9% wore gloves and 36.0% recapped needles after use. The concept of washing and disinfection after BEA was known by 68.8%. The disinfectant applied was correct for 21.9% of the cases, the time of application for 69.5%. Consulting a referring physician after BEA was mandatory for 32% of them. The time limit of 48 hours delay for the declaration of BEA was experienced by 51.3%. Among staff interviewed 82 caregivers (64.1%) experienced at least one BEA. Students and nursing students were most at risk. Needle pricks were the most frequent (73.2%). BEA is a major problem in the Segou Nianankoro Fomba Hospital. Compliance with standard precautions is not of common practice. Post-exposure care is not widely known. The experienced cases show poor management of BEA in the structure.

Blood exposure accidents are the source of major risks of contamination of healthcare personnel. The objective of this study was to describe the knowledge of standard precautions, and the attitudes and practices of nursing and midwifery students in relation to this accidental exposure. This cross-sectional survey, conducted in November 2011, was based on voluntary anonymous questionnaires completed by students working in the medical ward of the Bobo-Dioulasso teaching hospital. Of the 275 students asked to participate, 219 (92.8%) completed the questionnaire: 138 (63,0%) were student nurses and 81 (37.0%) student midwives. Their mean age was 27.9 ± 5 years. Among them, 64 (29.1%) acknowledged accidental exposure to blood during treatment performed as part of their hospital work. Only 30 of these 64 cases were reported at the time. The standard precautions for the prevention of these accidents were known to 131 students (59.8%); 58.4% always wore gloves for invasive procedures; 74.9% reported that the syringe container was "always" or "often" used. The needles used were "always" or "often" recapped before disposal in only 39.1% of cases. Only 11.0% were fully vaccinated against hepatitis B. Blood exposure accidents were not uncommon among these students and their knowledge of the standard precautions and actions to take in case of an accident is insufficient. These data show the need for further training and awareness campaigns to improve these hospital practices.

Physicians are asked to complete certificates within their profession. These certificates relate to various aspects of an individual's life, from birth to the end of life. The nature of requests is striking by its diversity. As a first step, the authors recall the outline of a certificate and its structure, as well as traps, hazards and risks to avoid. In a second step they describe three specific situations for the certificate: in the context of work accidents, common law accidents and social matters. All materials can not be treated in this space, so they refer the reader to the main bibliographic sources useful in this matter.

In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste.We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient.Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001).The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.

First responders are sometimes confronted with external uncontrolled haemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agents were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic perineal trauma for whom the use of a haemostatic bandage QuikClot ACS+™ (Z-Medica) seemed to us particularly useful in prehospital setting.

The development of addictive behaviors is a source of worry and concern for workplace and occupational physicians. To estimate the prevalence of behaviors, two types of surveys can be carried out: self-assessment surveys and biological testing in the workplace. For the latter, when a settlement is within the company, the prevalence is often lower compared to those enterprises that have not adapted this policy. Very few investigations have been published in France to date. Data published by the United Nations Office against Drugs and Crime (UNODC) shows a stable consumption of illicit substances in recent years. They reported consumption in the world among the general population (all subjects aged 15 to 64). For France, were described a prevalence estimated in 2005 to 8.6%, 0.6% and 0.2% for cannabis, cocaine and amphetamine derivatives, respectively, and in 2007 to 4.6% for opiates. Some prevalence in the workplace have been reported in Europe in chemical, petrochemical, metallurgical, automotive, in the transport sector and in medical and military fields. However, it appears that few surveys in the workplace have been published in France, this lack may be explained by a desire for anonymity on the subject at the level of company management and doctors work that focus on individual support with the problem of addiction. Screening for illicit substances is necessary because these psychotropic substances affect alertness and pose risks in the workplace, especially such that the association cannabis-alcohol further increases the risk. Knowledge of consumption is, moreover, an important factor in job security. It may be acquired if reliable methods, inexpensive to allow routine screening. Publication of results will reveal the extent of the problem and implement more effective campaigns of information and prevention in the workplace.

Tendon injuries are common in hand wounds and their functional consequences are not negligible. In emergency, tendon repairs techniques are well codified to restore function. These tendon repairs can be made in one session, in two sessions, or even use tendon transfers. Tendon transfers are not usual in the emergency but more common in the treatment of sequelae or failure of primary repair. We report one case of transfer to restore thumb flexion in emergency.

After describing the socio-economic background of the 18th and early 19th centuries, this article explains the parliamentary initiatives undertaken by the newly-independent Belgian state. The Industrial Accidents Act was passed in 1903, together with other social legislation and created a new area of law, separate from the civil law. In the course of the 20th century repeated additions were made to this law, including, in 1967, the transformation of the original contingency budget into a Fund for Industrial Accidents. The author then goes on to discuss the Fund's role and duties; how it is financed; and the procedures to be followed in the event of an industrial accident.

The post-traumatic epilepsy is responsible for 20% of the symptomatic epilepsies. Accidents on public highway constitute more than 70% of the causes. We report a singular case of fronto-polar post-traumatic epilepsy by zebu goring which appeared two years after the traumatism. The neurological examination of the patient was normal apart from a inconspicuous expansiveness of humor underlined by an excess of familiarity and hypersyntony. The cerebral scanner revealed a left fronto-basal cortico-under-cortical low density up to the homolateral fronto-polar area. The electroencephalogram (EEG) showed some left fronto-polar bursts of spike and wave on a normal bottom line. This clinical observation draws our attention on the fact that in Sahelian tropical environment where bovine breeding holds a major place, the cranio-encephalic traumatism by goring is not rare and can be responsible for epilepsy in the same way as accidents on public highway, or ballistic traumatism.

Tetanus is still a major health problem in Sénégal. In order to understand some of these reasons, we conducted a study. The aim of this study is to assess ironworkers' knowledge, behaviors and practices about tetanus. This knowledge, behaviors and practices survey was carried out in ironworks of two neighborhoods of Dakar from April 5 to May 10, 2008. 41 ironworks were identified and 32 agreed to participate in the study. In this ironworks, 120 ironworkers were interviewed. Their average age was 29 years +/- 15, education in French schools was low and 78.3% of them had a source of information. Despite some inaccuracies, most ironworkers were aware of tetanus (97.5%), severity (93.3%), causes (89.2%). However 35% did not evaluate the risk of tetanus and almost all the ironworkers or 96.7% had no preventive measures after injury. Moreover, no ironworker was fully immunized against tetanus. In some occupations at risk, awareness of tetanus should be increased by all available channels and methods emphasizing the importance of prevention.

Acute or subacute chemical-induced lung injury is rarely compound specific and is most often caused by an accidental occupational, domestic or environmental exposure to an inhaled chemical agent. The industrial disaster that happened in Bhopal in 1984, accidental poisoning with chlorine and petroleum hydrocarbons and also vesicant gases used during conflicts, are specific examples. Rarely, a chemical agent can cause lung damage by being ingested and reaching the lung through the systemic circulation (for example accidental or deliberate paraquat ingestion). Household accidents should not be underestimated. An important cause of household accidents is chlorine inhalation resulting from mixing bleach with acids such as the scale removers used to clean toilets. Chemical agents can provoke direct and/or indirect damage to the respiratory tract. The acute or subacute clinical manifestations resulting from inhalation of chemical agents are very varied and include inhalation fevers, acute non-cardiogenic pulmonary oedema, adult respiratory distress syndrome, reactive airways dysfunction syndrome and acute or subacute pneumonitis. The site and the severity of chemical-induced respiratory damage caused by inhaled chemical agents depend mainly on the nature and the amount of the agent inhaled. The immediate and long-term prognosis and possible sequelae are also variable. This review excludes infectious or immunologically induced acute respiratory diseases.

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as “water on the knee”), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

The authors report in the treatment of fractures of the proximal phalanx of the fingers, the use of Eiffel Tower pinning, a relatively simple method, fast and stable, associated to a protection and early rehabilitation. The objective of this method is to offer to the patient a pollici-digital grip. Our study is a retrospective study of 45 patients treated for fractures of the proximal phalanx of the fingers by percutaneous pinning according to Eiffel Tower method. We detail this simple and economic technique and examine the functional and radiological results of this series of patients. The amplitude of the active total motion of the proximal interphalangeal joint is on average 94.16 degrees (78.5 % of the normal active mobility of the proximal interphalangeal joint), and the amplitude of the active total motion of the metacarpo-phalangeal joint is on average 90.05 degrees (75 % of the normal active mobility of the metacarpo-phalangeal joint).

Occupational eye trauma causes injuries with often serious socioprofessional, medical-legal, and economic consequences, not only for workers themselves, but also for employers. In spite of today's legislation and the efforts to encourage prevention, the frequency of occupational ocular accidents remains relatively high despite how easy it is to protect the eyes. In this study, the reasons that these accidents persist despite the progress made in preventive measures was investigated.From January to July 2005, we analyzed the parameters related to 175 occupational eye injuries. All patients agreed to take part in this study, which was carried out in the emergency unit of the Ophthalmology Clinic at Geneva University Hospital. Additional data was collected in companies.Construction workers were the most exposed (41.1%). The activity with the greatest risk was grinding (19.4%). The most affected structure of the eye was the cornea (84%), 72.6% patients were not equipped with ocular protection at the time of the accident, and 17.4% wore poorly adapted eye protection. This can be explained by negligence, lack of awareness, etc. Overall, workers, employers, and the legislation in force are all responsible.Our results are comparable with those found in the literature, with certain particularities because heavy industry was underrepresented in our sample. Analysis of the law on the prevention of occupational accidents and diseases shows that the worker is not sufficiently aware of his responsibilities. To our knowledge, the legal aspects treated herein have not been studied. As done in certain studies, we emphasize the importance of preventive ophthalmologic examinations as well as improvement of both working conditions and worker awareness in the workplace.Primary prevention must be reinforced. Information campaigns within the workplace aimed at workers and revision of the laws on occupational safety are some of the recommendations that are proposed to control occupational ocular accidents.

We report the clinical case of a 26-year-old victim of a macular injury by high energy laser. The patient was examined in the emergency unit the first day with a retinophotography. He was followed up at 1 week, 3 weeks, and 3 months with an ophthalmologic exam, a retinophotography, and an OCT. The lesions progressed from edema with macular hemorrhage to macular necrosis and then to a macular hole. The macular injury by high energy laser was responsible for a necrotic modification of the macula preceding the formation of the macular hole.