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Résumé Cet article décrit tout d’abord une situation d’enseignement-apprentissage dans laquelle l’enseignante organise son travail à distance avec une activité individuelle d’analyse de situation et d’identification de critères de réussite, puis un travail en sous-groupes dont la tâche est guidée par les critères d’évaluation précédemment identifiés. Dans un deuxième temps, il met en évidence, en s’appuyant sur des concepts didactiques, les effets potentiellement positifs que peut représenter la distance dans une situation comme celle-ci. Enfin, un point de vue philosophique proposera quelques pistes de lecture de cette situation dans laquelle la contrainte (de la distance) favorise une lecture de l’autonomie et de l’agentivité des personnes en formation et en évaluation comme des rythmes qui se construisent dans une société qui ne cesse d’accélérer. Summary This article first describes a teaching-learning situation in which the teacher organizes her distance work with an individual activity of situation analysis and identification of success criteria, followed by work in sub-groups whose task is guided by the previously identified evaluation criteria. In a second step, the teacher then highlights, on the basis of didactic concepts, the positive effects that distance can have in a situation such as this. Finally, a philosophical point of view will propose some avenues for reading this situation in which the constraint (of distance) favours a reading of the autonomy and agency of people in training and evaluation as rhythms that are constructed in a society that is constantly accelerating.

The aim of this prospective study was to compare the results of cholecystectomy for acute cholecystitis through laparoscopic and open approach and to assess factors responsible for conversion into laparotomy.From January 1991 to October 1997, 200 patients with calculous acute cholecystitis were operated on in the same center, 100 through laparoscopy and 100 through laparotomy. Choice between these two procedures was only dependent on the disresponsibility of videolaparoscopic material. Comparison between laparoscopy and laparotomy groups concerned postoperative mortality and morbidity rates, hospital stay duration and late results. Intraoperative conversion into laparotomy occurred in 24 patients and factors responsible for conversion were assessed with univaried and multivaried analysis.Both groups were comparable with regard to sex ratio, age, ASA score but associated diseases incidence, plastron, fever above 38 degrees C and leucocytosis were significantly more frequent in the laparotomy group and delay between diagnosis and surgery was significantly longer in the laparoscopic group. There were two postoperative deaths in the laparotomy group, 0 in the laparoscopic group (NS). Morbidity rate was higher (32% versus 10%) (p = 0.0002) and hospital stay longer (12 +/- 10 days, versus 5 +/- 3) in the laparotomy group (p = 0.00005). Late results were similar in both groups. Conversion rate into laparotomy was 24%. Factors predisposing significantly to conversion were in univaried analysis: plastron, fever above 38 degrees C, leucocytosis, delay between diagnosis and surgery above 4 days, presence on ultrasonography of pericholecystic liquid and gallbladder wall edema, presence of "Klebsiella" in gallbladder bile. With multivaried analysis, leucocytosis and delay between diagnosis and surgery were the only independent factors.Videolaparoscopic cholecystectomy is a safe and efficient technique in the treatment of acute cholecystitis, with a lower postoperative morbidity rate and a shorter hospital stay. Conversion rate into laparotomy is significantly dependent on leucocytosis and delay between diagnosis and surgery. Laparoscopic cholecystectomy should be performed as soon as possible in acute cholecystitis.

SCOPUS: ar.j, info:eu-repo/semantics/published