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Élaboré sous la direction de Daniel Filâtre et Gilbert de Tersac, avec la collaboration de 24 universitaires spécialistes des politiques publiques, cet ouvrage est le résultat d’une véritable aventure collective. Faisant suite à un colloque sur le même thème, l’ensemble des réflexions ici réunies donne des repères sur les différents concepts des dynamiques intermédiaires, aujourd’hui « au cœur de l’action publique ». À travers des exemples, augmentés d’études ...

Aim: The objective was to compare Carotid Endarterectomy (CEA) with Carotid Artery Stenting (CAS) in terms of efficacy and safety in patients with symptomatic and asymptomatic extracranial carotid stenosis., Materials: This study enrolled 285 patients with symptomatic and asymptomatic carotid stenosis that underwent either to CAS or CEA. The primary end-points were death, stroke and myocardial infarction. The secondary end-points were restenosis and nerve injury. The Data emerged from the follow-up at 1,3,6,12,24 months that provided for clinical and EcocolorDoppler monitoring. A separate analyse was performed evaluating the prediction of the Ultrasonographic appearance of the atheroma on the symptomatic nature of the lesion., Results: The percentage of neurological symptomatology in the periprocedural period was higher in CAS than in CEA group (9% vs 3%). We didn't report any case of periprocedural death. The results from the follow-up are: myocardial infarction 5% CAS vs 7% CEA; stroke 5% CAS vs 4% CEA; restenosis 3% CAS vs 6% CEA; nerve injury 0% CAS vs 1% CEA; mortality 0% CAS vs 1% CEA., Discussion: CEA is the gold standard for treatment of significant carotid stenosis, although endovascular technique is emerging as a less invasive alternative. CAS has presented a less frequence of myocardial infarction, nerve injury and long-term mortality, but it showed an higher percentage of neurological events both in short and long-term. This last aspect is correlated with the plaque structure. Ultrasonographic study of the atheroma has become a defining moment in the choice of the therapeutic strategy.

In this paper, a case report of acute pulmonary oedema following thyroidectomy in a 51-year-old male patient is reported. The aetiological factor was vigorous inspiratory effort against an obstruction of the upper airway occurring immediately after extubation. The patient was transferred to intensive care unit and treated with CPAP ventilation. He recovered completely after 48 hours. The pathogenesis of both laryngospasm and an unexpexted but potentially serious complication such as negative-pressure pulmonary oedema is discussed.

Intraoperative fluid administration is considered an important factor in the management of metabolic acidosis following surgical procedures. The aim of this study was to compare three types of intraoperative infusional models in order to evaluate their effect on acid-base changes in the immediate postoperative period as calculated by both the Henderson-Hasselbach equation and the Stewart approach. Forty-seven patients undergoing left hemicolectomy were enrolled in the study and assigned randomly to receiving 0.9% saline alone (Group A, n=16), lactated Ringer's solution alone (Group B, n=16) or 0.9% saline and Ringer's solution, 1:1 ratio (Group C, n=15). Arterial blood samples were taken before operation (t0) and 30 min after extubation (t1) in order to measure the acid-base balance. The results showed a metabolic acidosis status in Group A patients, whereas Group B exhibited metabolic alkalosis only by means of the Stewart method. No difference was found in Group C between the time points t0 and t1 when using either the Henderson-Hasselbach equation or using the Stewart model. We conclude that saline solution in association with Ringer's solution (1:1 ratio) appears to be the most suitable form of intraoperative fluid management in order to guarantee a stable acid-base balance in selected surgical patients during the immediate postoperative period.

We report the case of a young woman who underwent total thyroidectomy for a suspect nodular thyreopathy and occasionally happened to be affected simultaneously by vagus nerve schwannoma. Symptomatology is discussed and we propose a review of the literature about this non frequent pathology and discuss the latest diagnostic procedures and surgical indications and treatment.

The aim of this retrospective study was to assess the role of lymphectomy in the treatment of well differentiated and aggressive carcinomas of the thyroid gland. From 1987 to 2002, 231 patients were operated on in our Division; 97 were male (42%) and 134 female (58%), with a mean age of 48 years (range 17-45). One hundred and ninety-four patients had well differentiated thyroid carcinomas, and 37 aggressive thyroid cancer. We performed a follow-up on 171/231 patients (74%) who underwent surgery from 1997 to 1998. Among the 143 patients with well differentiated neoplasms, 93 were treated with total thyroidectomy (65%), and 50 with total thyroidectomy with simultaneous or subsequent lymphectomy (35%); 92 patients underwent postsurgical radiomethabolic therapy (64%). Two patients developed non-functional metastases and died because of disease progression. Of the 28 patients affected by aggressive tumours, 8 underwent total thyroidectomy (29%) and 20 total thyroidectomy with simultaneous or subsequent central lymphectomy (71 %). All 28 patients with aggressive malignancies underwent postsurgical radiomethabolic therapy (100%). Three patients developed diffuse non-functional metastases and died because of disease progression.