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Lausanne, Switzerland

Gillion J.F.,Service de Chirurgie Viscerale
Journal of visceral surgery | Year: 2012

In clean surgery (Altemeier Class I), the incidence of infections is not increased by the placement of prosthetic material. Prosthetic mesh infections occur more frequently and are more serious in ventral incisional repair than in inguinal hernia repair. While removal of the mesh resolves the infectious problem, it creates other problems that are equally difficult. This underscores the need to: explore other conservative hernia treatment options; in the end, these are often feasible; respect and implement strict measures to prevent infection. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Hornez E.,Service de Chirurgie Viscerale
Journal of visceral surgery | Year: 2011

The hemodynamically unstable pelvic fracture are a diagnostic and therapeutic challenge. The current management is based on the control of pelvic bleeding by combining pelvic ring stabilization and embolization of pelvic arteries. The mortality of these patients, however, exceeds 30%. Recently the preperitoneal packing, based on the hemostatic tamponade of the pelvic cavity has been described. The objective of this study was to evaluate the interest of this new surgical procedure. The effectiveness of the standard algorithm is evaluated by analysis of pelvic injuries in 200 severe trauma treated at the Sainte-Anne Hospital. The results are then compared with literature data on the preperitoneal packing. The profile injury, management and morbidity and mortality was evaluated in 200 polytrauma. After an initial phase of resuscitation, unstable pelvic fractures were treated with a circumferential belt followed by the application of an external fixator. Arteriography was performed for all patients with persistent hemodynamic instability. The mean injury severity score (ISS) was 31 (4-75). The mean trauma-related injury severity score (TRISS) was 74% (3-99). The proportion of hemodynamically unstable patients was 47%. Fifteen patients (41%) had severe bleeding. The median number of blood transfusion was 10 (4-42); eight patients (22%) underwent embolization. For two patients, reducing the pelvic fracture with an external fixator resulted in permanent hemostasis. Two patients underwent a laparotomy first, for the control of a hemoperitoneum. The mortality rate of the group of patients with hemorrhage was 33% (5/15). This high mortality leads to reconsider the place of pelvic embolization as firstline treatment. Some major drawbacks are noted: its effectiveness in treating venous bleeding, availability and duration of the procedure. The preperitoneal packing is a fast and effective surgical alternative. It seems to improve hemodynamic status of patients and significantly reduce the use of embolization and massive transfusion. Embolization is still indicated for patients not responding to surgery. However survival is not significantly improved. Copyright © 2011. Published by Elsevier Masson SAS.

Donatelli G.,Unite dEndoscopie Interventionnelle | Ferretti S.,Hopital University Antoine Beclere | Vergeau B.M.,Unite dEndoscopie Interventionnelle | Dhumane P.,Lilavati Hospital and Research Center | And 9 more authors.
Obesity Surgery | Year: 2014

Background: Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved. Methods: In 21 pts (18 F, 41 years), one or two plastic pigtail stents were delivered across the leak 25.6 days (4-98) post-surgery. In all patients, nasojejunal tube was inserted. Check endoscopy was done at 4 to 6 weeks with either restenting if persistent leak, or removal if no extravasation of contrast in peritoneal cavity, or closure with an Over-the-Scope Clip® (OTSC®) if contrast opacifying the crossing stent without concomitant peritoneal extravasation. Results: Twenty-one out of 21 (100 %) patients underwent check endoscopy at average of 30.15 days (26-45) from stenting. In 7/21 (33.3 %) patients leak sealed, 2/7 needed OTSC®. Second check endoscopy, 26.7 days (25-42) later, showed sealed leak in 10 out 14; 6/10 had OTSC®. Four required restenting. One patient, 28 days later, needed OTSC®. One healed at 135 days and another 180 days after four and seven changes, respectively. One patient is currently under treatment. In 20/21 (95.2 %), GL have healed with EID treatment of 55.5 days (26-∈180); all are asymptomatic on a normal diet at average follow-up of 150.3 days (20-276). Conclusions: EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required. © 2014 Springer Science+Business Media.

Hanaire H.,Pole Cardio vasculaire et Metabolique | Dubet A.,Pole Cardio vasculaire et Metabolique | Chauveau M.-E.,Pole Cardio vasculaire et Metabolique | Anduze Y.,Service de Chirurgie Viscerale | And 3 more authors.
Obesity Surgery | Year: 2010

Hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report shows that continuous glucose monitoring can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-h fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, continuous glucose monitoring is a very useful tool revealing the episodes in free living circumstances and can be used to monitor the treatment success. © 2009 Springer Science + Business Media, LLC.

The authors of the present article propose adjustments to the parentbaby psychotherapy framework in light of recent theoretical, clinical and technical findings in perinatal psychopathology. The points of view put forth here are based on a review of the literature of early therapies and their evolution in order to look more closely at the indications for this type of treatment as well as its epistemological, semiological, material, technical and therapeutic aspects. Because of this, the very clear position of the authors in their role as child-centered caregivers has brought them to think about the encounter with the baby and his parents, to formulate à framework, to organize the time, space and objects for each session and to accompany the therapeutic process as a function of their identification with the baby's situation. Finally, an account of psychotherapy illustrates the way in which the complexity of this type of clinical work imposes a permanent questioning as to how the therapists operate in terms of containment, third-party position, otherness, differentiation, metaphorisation and transformation of psychic processes.

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