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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.

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.

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.