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Resume Objectifs Evaluer la creation d’une activite de PICC-lines pediatrique dans un CHU apres les 91 premieres procedures consecutives. Materiels et methodes Etude retrospective portant sur une periode de 24 mois : les criteres analyses ont ete le succes ou l’echec de la procedure, l’indication, l’âge de mise en place, le type de PICC-line, la duree moyenne d’utilisation et l’apparition de complications telles qu’un retrait accidentel, une thrombose veineuse ou une infection. Resultats Quatre-vingt-onze PICC-lines ont ete mis en place chez 74 patients, âges de quatre mois a 25 ans (sex-ratio : 1,1 filles/garcons). La procedure a ete realisee sous anesthesie generale dans quatre cas (4,4 %) et sous EMLA et MEOPA dans 87 cas (95,6 %). L’insertion echo-guidee s’est faite dans la veine basilique (n = 63, 70 %), humerale (n = 18, 20 %) ou cephalique (n = 9,10 %) du bras non dominant (G dans 62 cas, D dans 28 cas). Le taux de reussite de mise en place a ete de 99 % (n = 90). Les indications principales etaient la mise en place d’une antibiotherapie (n = 47, 52 %), chimiotherapie (n = 34,38 %) et d’une nutrition parenterale (n = 5, 5 %). Le dispositif utilise etait un catheter simple lumiere 3F (n = 4, 4 %), simple lumiere 4F (n = 31, 34 %), double lumiere 4F (n = 2, 2,2 %), simple lumiere 5F (n = 12, 13 %) et double lumiere 5F (n = 41, 45 %). La duree moyenne d’utilisation du PICC etait de 45 jours (14 a 300 jours). Les complications observees etaient un retrait accidentel (n = 2, 2,2 %), fracture du catheter (n = 2 ; 2,2 %), occlusion (n = 5, 5,5 %), infection suspectee (n = 1, 1,1 %), thrombose veineuse et embolie pulmonaire (n = 3, 3,3 %). Le taux global de complications a ete estime a 14,4 % (n = 13), dont 4,4 % de complications graves (n = 4). Conclusion Les PICC-lines representent une perspective d’avenir en pediatrie. Cette technique est fiable et presente un taux de complications similaire aux etudes realisees chez l’adulte, dont la plupart peut etre prevenue par un entretien soigneux du catheter et une information du personnel soignant.

Introduction The present study aimed to compare the long-term results of transanal haemorrhoidal dearterialisation (THD) with mucopexy and stapler haemorrhoidopexy (SH) in treatment of grade III and IV haemorrhoids. Methods One hundred and twenty-four patients with grade III and IV haemorrhoids were randomised to receive THD with mucopexy (n=63) or SH (n=61). A telephone interview with a structured questionnaire was performed at a median follow-up of 42 months. The primary outcome was the occurrence of recurrent prolapse. Patients, investigators and those assessing the outcomes were blinded to group assignment. Results Recurrence was present in 21 patients (16.9%). It occurred in 16 (25.4%) in the THD group and 5 (8.2%) in the SH group (p=0.021). A second surgical procedure was performed in eight patients (6.4%). Reoperation was open haemorrhoidectomy in seven cases and SH in one case. Five patients out of six in the THD group and both patients in the SH group requiring repeat surgery presented with grade IV haemorrhoids. No significant difference was found between the two groups with respect to symptom control. Patient satisfaction for the procedure was 73.0% after THD and 85.2% after SH (p=0.705). Postoperative pain, return to normal activities and complications were similar. Conclusions The recurrence rate after THD with mucopexy is significantly higher than after SH at long-term follow-up although results are similar with respect to symptom control and patient satisfaction. A definite risk of repeat surgery is present when both procedures are performed, especially for grade IV haemorrhoids.

Purpose To assess the efficacy, safety and gain in procedure time of the technique of balloon occlusion hepatic venography with iodinated contrast used to target the portal vein during TIPS. The technique is assessed versus wedged hepatic venography. Materials and methods Fifty-eight TIPS were prospectively included. The portal vein was located in 30 cases by the wedged hepatic venography (group 1) and in 28 cases by balloon occlusion hepatic venography (group 2). To compare both techniques a “portogram quality” score was defined using a 5 points scale. The time required to achieve portal puncture was also recorded. The complications of both procedures were assessed and classified in groups as intrahepatic hematoma or intraperitoneal hemorrhage. Results The right portal vein was visualized in a significantly higher number of patients using balloon than with wedged retrograde venography 71.3% (20/28) versus 13.3% (4/30) respectively ( P = 0.002). The quality score for the portogram was significantly higher for balloon hepatic venography 2.21 than for wedged hepatic venography 1.07 ( P = 0.002). The mean time required to puncture the portal vein was significantly shorter when the right branch of the portal vein was visualized 21 min versus 33.5 min ( P = 0.046). We recorded one intrahepatic hematoma (3.3%) and 4 intraperitoneal hemorrhage (13.3%) secondary to wedged hepatic venography. There were no complications with balloon occlusion hepatic venography ( P = 0.053). Conclusion The use of balloon occlusion hepatic venography improves the quality of the retrograde portal venography to target the portal vein and decreases procedure time. The balloon technique is also burdened with fewer complications than the standard wedged hepatic venography.

RESUMO- A incidencia de Transtorno de Estresse Pos-Traumatico (TEPT) e um tema ainda pouco abordado pela literatura cientifica no Brasil, principalmente relacionado a doencas traumaticas como câncer de mama. Este estudo foi realizado com 20 mulheres mastectomizadas, e revelou a incidencia de TEPT em 20% desta amostra, atraves da escala CAPS (Clinician Administered PTSD Scale), a IES ( Impact of Events Scale) e a SOS (Significant Other Scale), foi realizada tambem uma entrevista semi-estruturada para verificar o historico da doenca e seu impacto fisico e social. A familia foi relatada como principal rede de apoio social, seguido do parceiro, amigos, igreja e profissionais da saude. A assistencia psicologica se apresenta de forma majoritaria no periodo posoperatorio. Observou-se entao uma grande lacuna a ser trabalhada pelo profissional psicologo de maneira preventiva com relacao ao trauma gerado pelo câncer de mama que segundo o ministerio da saude e o tipo de câncer de maior incidencia nas mulheres

By "acute scrotum" is meant a sudden, painful tumefaction in one or both testicles with local and systemic symptomatologies. It can be caused by spermatic cord torsion in about 50% of cases in paediatric age, while in adults such a cause is much rarer. In addition to the clinical examination, Doppler, eco colour-Doppler and scintigraphy with 99mTc pertecnetate may be of use even though these investigations are not often immediately employable. In addition, as the hours pass, the damage caused to the gonad becomes irreversible; this, of course, influences therapeutic conduct. Starting from the description of a recently observed case of torsion of Morgagni's hydatid, the authors discuss the importance of differential diagnosis to protect the vitality of the testicle and show that surgical exploration, in cases where a definite aetiological diagnosis is missing, is the preferable and most rational therapeutic choice.

Postoperative chylous ascites is a rare clinical condition that occurs as a consequence of disruption of the abdominal lymphatics after retroperitoneal dissection. Generally the management is conservative based on a low fat diet and total parenteral hyperalimentation. However, such therapy requires weeks to months before resolution of the ascites. On the other hand, surgical approach is associated with a high failure rate to ligate leaky lymphatics. The Authors, therefore suggest a surgical resolution of the ascite with the use of fibrin glue to occlude rapidly and permanently the lymphatics ruptured.

A large malignant adrenocortical carcinoma extending to the inferior vena cava and right atrium presented in the form of hemoptysis. Magnetic resonance imaging allowed precise evaluation without any other invasive procedure. Cardiopulmonary bypass is usually employed in these circumstances to remove the cavo-atrial thrombus. This approach may be advantageously replaced by the use of total vascular exclusion of the liver. The only unusual feature of the procedure is that the upper caval clamp is applied across the right atrium. Major collateral circulation due to caval thrombosis allows complete resection of the inferior vena cava up to the hepatico-caval confluence without the need for prosthetic replacement. After an uneventful postoperative course, malignant spread despite chemotherapy with op'-DDD led to death 4 months after surgery.

Objectifs Evaluer l’apport d’une acquisition double energie pour l’exploration des bifurcations carotidiennes. Materiels et methodes Inclusion prospective de 8 patients pour angioscanner dans l’exploration d’une stenose carotidienne. Acquisition double energie (Somaton, Siemens, Germany) apres injection de 70 cc a 5 cc/s d’iode. Les constantes etaient : tube A : 140 Kv, 56 mAs tube B : 80 kv, 234 mAs. Une reconstruction realisee avec le filtre B30f servait de reference. Les reconstructions realisees avec le filtre D30f etaient traitees par le logiciel specifique. L’analyse portait sur des criteres qualitatifs : qualite globale des images gradee sur une echelle de 4, le caractere calcifie de la stenose, temps de reconstruction et quantitatifs : degres de stenoses, quantite d’irradiation delivree. Resultats La qualite des images etait evaluee comme bonne ou excellente, la dose d’irradiation moyenne delivree etait evaluee a 300 mGy*cm, et le degre de stenose etait correctement evalue. L’avantage de la reconstruction double energie etait manifeste pour les stenoses calcifiees puisqu’elle permettait la detection automatique des zones calcifiees par rapport aux zones opacifiees par l’iode. La difficulte du post-traitement reside dans le seuillage de reconnaissance des calcifications. Conclusion L’acquisition double energie pour l’exploration des stenoses carotidiennes est possible et peu irradiante. Des progres sont necessaires dans l’automatisation du seuillage.

Claudio Iovino,1 Giuseppe Giannaccare,2 Marco Pellegrini,2 Federico Bernabei,2 Mirco Braghiroli,1 Tomaso Caporossi,3 Enrico Peiretti1,4 1Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; 2Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy; 3Department of Ophthalmology, Ospedale Careggi, Firenze, Italy; 4Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, ItalyCorrespondence: Enrico PeirettiEye Clinic, University of Cagliari, Via Ospedale 48, Cagliari 09124, ItalyTel|Fax +390706092319Email enripei@hotmail.comPurpose: To evaluate the efficacy and safety of combined 25-gauge (G) pars plana vitrectomy (PPV) with intravitreal dexamethasone implant (DXI) for the treatment of advanced stage epiretinal membrane (ERM).Methods: Forty consecutive pseudophakic eyes with idiopathic stage 3–4 ERM and intraretinal cysts were randomly assigned to two treatment groups. Twenty eyes underwent combined 25-G PPV, ERM peeling and slow-release DXI (DEX group), whereas 20 eyes underwent standard 25-G PPV with ERM peeling only (control group). Differences in postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) were evaluated.Results: In all patients, BCVA significantly increased at 1, 3 and 6 months after surgery compared to baseline (all p < 0.05), but at 3 and 6 months, the visual gain was higher in the DEX group (respectively, p = 0.036, p = 0.006). CMT was significantly lower in DEX group compared to control group at 3 and 6 months after surgery (respectively, p = 0.042, p = 0.003). There was no statistically significant difference in IOP change over the course of the follow-up between groups (p > 0.05).Conclusion: Combined 25-G PPV with DXI is associated with better anatomical and functional outcomes in patients with advanced stage ERM.Keywords: epiretinal membrane, intravitreal dexamethasone, macular pucker, intraretinal cysts