Preventing the contamination of hospital personnel by cytotoxic agents: evaluation and training of the para-professional healthcare workers in oncology units.

This study was specifically focused on para-professional healthcare workers (PHCWs) who handle cytotoxic drugs and contaminated wastes at the Public Teaching Hospitals of Marseille (AP-HM), France. It first aimed at evaluating the knowledge and professional practice of the PHCWs who belong to a personnel category among the less informed and protected in hospitals. In a second time, this study also proposed to raise awareness, educate and train the staff on protective measures to minimise the exposure of the PHCWs to the potential toxicity of anticancer chemotherapy agents (or metabolites) when cleaning and handling both cytotoxic drugs and wastes. Among the 11 oncology units evaluated, 82% completed an assessment survey, 63% of which were PHCWs. Out of nine oncology units assessed, 89% reported limited knowledge of the general risk and of the safe handling of cytotoxic drugs, 89% reported using vinyl gloves which are the less protective ones. Forty-four per cent of the units used wet sweeping techniques for cleaning the floors, and 11% of the units did not have specific procedures for cleaning the equipments used for collecting contaminated excreta. Protective outer apparel was not always worn and chemotherapy wastes were not managed consistently between all units. Standardized procedures and guidelines to prevent occupational exposure were not used by PHCWs. More education and training are needed to improve safety.

The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review.

Turnbull and Cutait described abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) in 1961. DCA could reduce anastomotic leaks, pelvic morbidity and use of stomas. Strong evidence about its clinical benefits is still lacking. This systematic review examined the clinical outcomes of DCA for the treatment of malignant or benign colorectal conditions. A systematic search of electronic medical databases was conducted. Two independent reviewers selected studies, extracted data and assessed risk of bias. The primary outcome was pelvic morbidity (anastomotic leak, pelvic abscess or sepsis, use of stoma). Fecal continence and survival data were also analyzed. From 1,251 citations, we included seven observational studies including 1,124 patients. All included studies were considered at high risk of bias. Two studies comparing DCA with immediate anastomosis reported a significant decrease in anastomotic leak, and pelvic abscess or sepsis. Low rates of pelvic morbidity were reported in the other five studies: anastomotic leak 0-7 %, pelvic abscess 0-11.8 % and pelvic sepsis 6.8-10 %. Rates of permanent stoma after DCA were low in six studies (1-6 %), with one study reporting an incidence of 25 %. Fecal continence was reported as satisfying in all studies. No differences were observed in a comparative setting. Survival data were reported in four studies. Clinical heterogeneity and methodological issues precluded meta-analysis. Based on retrospective evidence, DCA offers a low rate of anastomotic leak, pelvic morbidity and use of stoma, with reasonable fecal continence. Results are encouraging, but prospective studies are needed for comparison with standard of care.

Ultralow-energy amorphization of contaminated silicon samples investigated by molecular dynamics.

Ion beam processes related to focused ion beam milling, surface patterning, and secondary ion mass spectrometry require precision and control. Quality and cleanliness of the sample are also crucial factors. Furthermore, several domains of nanotechnology and industry use nanoscaled samples that need to be controlled to an extreme level of precision. To reduce the irradiation-induced damage and to limit the interactions of the ions with the sample, low-energy ion beams are used because of their low implantation depths. Yet, low-energy ion beams come with a variety of challenges. When such low energies are used, the residual gas molecules in the instrument chamber can adsorb on the sample surface and impact the ion beam processes. In this paper we pursue an investigation on the effects of the most common contaminant, water, sputtered by ultralow-energy ion beams, ranging from 50 to 500 eV and covering the full range of incidence angles, using molecular dynamics simulations with the ReaxFF potential. We show that the expected sputtering yield trends are maintained down to the lowest sputtering yields. A region of interest with low damage is obtained for incidence angles around 60° to 75°. We also demonstrate that higher energies induce a larger removal of the water contaminant and, at the same time, induce an increased amorphization, which leads to a trade-off between sample cleanliness and damage.

Influence of water contamination on the sputtering of silicon with low-energy argon ions investigated by molecular dynamics simulations.

Focused ion beams (FIB) are a common tool in nanotechnology for surface analysis, sample preparation for electron microscopy and atom probe tomography, surface patterning, nanolithography, nanomachining, and nanoprinting. For many of these applications, a precise control of ion-beam-induced processes is essential. The effect of contaminations on these processes has not been thoroughly explored but can often be substantial, especially for ultralow impact energies in the sub-keV range. In this paper we investigate by molecular dynamics (MD) simulations how one of the most commonly found residual contaminations in vacuum chambers (i.e., water adsorbed on a silicon surface) influences sputtering by 100 eV argon ions. The incidence angle was changed from normal incidence to close to grazing incidence. For the simulation conditions used in this work, the adsorption of water favours the formation of defects in silicon by mixing hydrogen and oxygen atoms into the substrate. The sputtering yield of silicon is not significantly changed by the contamination, but the fraction of hydrogen and oxygen atoms that is sputtered largely depends on the incidence angle. This fraction is the largest for incidence angles between 70 and 80° defined with respect to the sample surface. Overall, it changes from 25% to 65%.

Exploring proteomes and analyzing protein processing by mass spectrometric identification of sorted N-terminal peptides.

Current non-gel techniques for analyzing proteomes rely heavily on mass spectrometric analysis of enzymatically digested protein mixtures. Prior to analysis, a highly complex peptide mixture is either separated on a multidimensional chromatographic system or it is first reduced in complexity by isolating sets of representative peptides. Recently, we developed a peptide isolation procedure based on diagonal electrophoresis and diagonal chromatography. We call it combined fractional diagonal chromatography (COFRADIC). In previous experiments, we used COFRADIC to identify more than 800 Escherichia coli proteins by tandem mass spectrometric (MS/MS) analysis of isolated methionine-containing peptides. Here, we describe a diagonal method to isolate N-terminal peptides. This reduces the complexity of the peptide sample, because each protein has one N terminus and is thus represented by only one peptide. In this new procedure, free amino groups in proteins are first blocked by acetylation and then digested with trypsin. After reverse-phase (RP) chromatographic fractionation of the generated peptide mixture, internal peptides are blocked using 2,4,6-trinitrobenzenesulfonic acid (TNBS); they display a strong hydrophobic shift and therefore segregate from the unaltered N-terminal peptides during a second identical separation step. N-terminal peptides can thereby be specifically collected for further liquid chromatography (LC)-MS/MS analysis. Omitting the acetylation step results in the isolation of non-lysine-containing N-terminal peptides from in vivo blocked proteins.

Effects of sodium sulfate on fecal pH and proliferation of colonic mucosa in patients at high risk for colon cancer.

High fecal pH level has been suggested as a risk factor for colorectal cancer. We previously demonstrated that, although sodium sulfate did not affect the proliferation rate of colonic mucosa, as indicated by thymidine-labeling index, it did lower fecal pH in subjects at average risk for colon cancer. In the current study, we evaluated the effects of sodium sulfate on fecal pH and proliferation of colonic mucosa in subjects at high risk for colon cancer. Fifty-seven patients who had had colonic polyps removed were randomly assigned to two groups to receive either sodium sulfate (27 patients) or a placebo (25 patients) at a mean dose of 4 g/day for 14 days. Age, sex, height, and weight were comparable in both groups. Before intervention, levels of fecal pH were similar in the two groups, but after intervention, fecal pH was reduced only in the sodium sulfate group (mean decrease, 0.3 U; P less than .01). Thymidine-labeling index (number of labeled cells per number of cells counted) was similar in the two groups prior to intervention and did not change significantly after intervention (mean increase, 0.9%; P = .35). Regression analysis revealed no correlation between the change in labeling index and the change in fecal pH. We conclude that high fecal pH level is only indirectly associated with the development of colon cancer and, therefore, may be a secondary, rather than a primary, measure of cancer risk.

Long-term effects of dietary calcium on risk markers for colon cancer in patients with familial polyposis.

There is conflicting evidence regarding the benefit of calcium in prevention of colon cancer. Patients who have undergone ileorectal operations for familial polyposis can be useful to study hypotheses on prevention of colon cancer. In this study we evaluated the effect of long-term calcium supplementation on risk markers of colon cancer. Thirty-one patients with familial polyposis, after subtotal colectomy, were randomized to group A, which received placebo, and group B, which received 1200 mg of calcium daily. Intervention lasted 9 months, in which they underwent four 3-monthly evaluations that included food records, fecal pH, calcium and bile acids, and rectal biopsy for thymidine labeling. Age, height, weight, macronutrients, and dietary fiber were comparable in both groups. More women were in the group that received placebo. Fecal pH, weight, and bile acid levels were similar before intervention and remained unchanged. Fecal calcium levels were similar before intervention and increased in the calcium group throughout the study (p less than 0.05). Labeling index of placebo and calcium groups was similar before intervention (4.8 and 6.1, respectively). After 3 months it was reduced in both groups (3.1 and 4.4, respectively; p less than 0.05). After 6 months it was reduced only in the calcium group (3.4; p less than 0.05). After 9 months it did not differ from the starting point (3.4 and 4.0, respectively). In a long-term intervention study with a homogenous group of patients with familial polyposis, supplemental dietary calcium did not affect mucosal risk factors for colon cancer.

Benfluorex as a therapeutic option for insulin resistance in HIV lipodystrophy syndrome.

BACKGROUND: HIV lipodystrophy syndrome, characterized by a significant excess of visceral adiposity and a reduced subcutaneous fat mass in association with insulin resistance and dyslipidemia, still affects the majority of antiretroviral-treated HIV-infected patients. The therapeutic management of this syndrome has not yet been well established. Benfluorex is known to decrease insulin resistance with no side effects on lactate levels in HIV-negative patients. METHOD: We conducted an open-label study of benfluorex (150 mg, 2-3 times a day) that was prescribed for 60 HIV-infected patients who were diagnosed with glucose metabolism abnormalities by oral glucose tolerance test (OGTT); 47 of these patients had visceral fat accumulation measured by computed tomography (VAT). Median follow-up was 12 months (interquartile range [IQR] = 6-12 months). The great majority of patients (90%) were treated with at least triple therapy (in 70% the therapy included at least one PI), with a nonsignificant change over the study period. RESULTS: Added to antiretroviral therapy, benfluorex improved OGTT in 47/60 cases, including total normalization in 34/60 without lactate concentration modification. A trend toward a decrease in VAT distribution was observed (p =.06). No significant difference was observed in subcutaneous fat distribution, although an increase in subcutaneous thigh adipose tissue was observed in 17/47 (36.2%) cases and 6 patients (12.7%) presented both subcutaneous fat increase and VAT decrease.

The effect of lowering faecal pH on the rate of proliferation of the normal colonic mucosa.

Epidemiological and animal studies suggest that faecal pH may be a risk factor for colorectal cancer with low faecal pH associated with a lower incidence of the disease. The aim of this study was to determine whether faecal pH (or dietary fibre) affects the short-term risk factors for colon cancer. Sixty-nine normal volunteers were randomized into three equal groups (A-C). They provided food records, faecal specimens and submitted to rectal biopsy for thymidine labelling studies before and after a 2-week intervention. Group A received a placebo of fruit juice. Group B, approximately 3.0 g d-1 sodium sulphate in juice. Group C, 30 g d-1 supplementary dietary fibre as wheat bran in bread. Age, sex, weight, height and intake of macronutrients and minerals were similar in the groups prior to intervention. Faecal pH was similar for the three groups before and was reduced in Group B after intervention (P = 0.001) with a relative reduction of 0.5 pH units. The labelling index for the three groups was similar prior to intervention; after, it was lowest in Group B with a relative reduction of 0.5% points, although this difference was not statistically significant. The results thus do not support the hypothesis that an acidification of faecal pH leads to a reduction in risk markers for colon cancer.

Local recurrence and survival after laparoscopic mesorectal resection forrectal adenocarcinoma.

BACKGROUND: Laparoscopic resection for rectal cancer is controversial. Actuarial survival and local recurrence rates have not been determined. METHODS: A prospective database containing 80 consecutive unselected laparoscopic resections of rectal cancers performed between November 1991 and 1999 was reviewed. Local recurrence was defined as any detectable local disease at follow-up assessment occurring either alone or in conjunction with generalized recurrence. The tumor node metastases (TNM) classification for colorectal cancers and the Kaplan-Meier method were used to determine staging and survival curves. The mesorectal excision technique was used during surgery. RESULTS: The median follow-up period was 31 months for patients with stages I, II, and III cancer, and 15.5 months for patients with stage IV cancer. The overall 5-year survival rate was 65.1% for all cancer stages and 72.1% for stages I, II, and III cancer. No trocar-site recurrence was observed. The overall local recurrence rate was 3.75% (3/80) for all cancer stages, and 4.3% (3/70) for stages I, II, and III cancer. CONCLUSIONS: The survival and local recurrence rates for patients with rectal cancer treated by laparoscopic mesorectal excision do not differ negatively from those in the literature for open mesorectal excision. Further validation is needed.

Predicting conversion in laparoscopic colorectal surgery. Fellowship training may be an advantage.

BACKGROUND: Laparoscopic colorectal surgery has clear advantages over open surgery; however, the effectiveness of the approach depends on the conversion rate. The objective of this work was to prospectively validate a model that would predict conversion in laparoscopic colorectal surgery. METHODS: A simple clinical model for predicting conversion in laparoscopic colorectal surgery was previously developed based on a multivariable logistic regression analysis of 367 procedures. This model was applied prospectively to a follow-up group of 248 procedures by the same team, including 54 procedures performed by one new fellowship-trained surgeon. RESULTS: Patients in the follow-up group were more likely to have cancer (56% vs 44%, p = 0.007) and were more obese (median, 71.0 vs 66.0 kg; p < 0.001). The rate of conversion in the follow-up group was unchanged (8.9% vs 9.0%, p > 0.05). Despite expected trends toward increasing risk of conversion with weight level (<60 kg, 6.8%; 60-<90 kg, 9.0%; >90 kg, 12.1%; p > 0.05) and malignancy (10.1% vs 7.3%, p > 0.05), the model did not distinguish well between groups at risk for conversion. Contrary to the model, however, the fellowship-trained surgeon had a conversion rate that was not higher than that of the other, more experienced surgeons (7.3% vs 9.3%, p > 0.05) even though he was less experienced, and operating on patients who were more obese (median, 75.0 vs 70 kg; p = 0.02) and more likely to have cancer (59% vs 55%, p > 0.05). Recalculated conversion scores that excluded the inexperience point for the fellowship-trained surgeon showed a good fit for the model. Considering the original and follow-up experience together (615 cases), the model clearly stratifies patients into low (0 points), medium (1-2 points), and high risk (3-4 points) for conversion, with respective rates of 2.9%, 8.1%, and 20% ( p = 0.001). CONCLUSION: This model appears to be a valid predictor of conversion to open surgery. Fellowship training may provide sufficient experience so that learning curve issues are redundant in early practice. This model now requires validation by other centers.

Laparoscopic resections for colorectal cancer: does conversion survival?

BACKGROUND: This purpose of this study was to examine whether survival is affected when laparoscopic resections for colorectal cancer are converted to open surgery. METHODS: A prospective database of 377 consecutive laparoscopic resections for colorectal cancer performed between November 1991 and June 2002 was reviewed. The TNM classification for colorectal cancer and the Kaplan-Meier method were used to determine survival curves for each group. RESULTS: Conversion to an open procedure was required in 46 cases (12.8%). Converted and laparoscopic groups were similar in age, sex, comorbidities, and location and size of tumor. The converted group had a significantly higher weight (75 kg vs 69 kg, p = 0.013) and conversion score (2.18 vs. 1.87, p = 0.005). Patients with stage IV disease were significantly more likely to be converted than those with stage I-III disease (23.0% vs 11.2%, p = 0.04). There was no difference in the conversion rate between patients with stage I (14%), II (8%), or III (13%) colorectal cancers. Median follow-up was 30.5 months for stage I-III and 10.8 months for stage IV cancers. There were 190 patients followed at least 2 years and 73 patients followed at least 5 years. Survival curves demonstrate significantly lower 2-year survival after converted procedures as compared to laparoscopic (75.7% vs 87.2%, p = 0.02), with a trend toward lower 5-year survival (61.9% vs 69.7%, p = 0.077). CONCLUSIONS: Survival rates at 2 and 5 years are lower for patients in the converted group compared to patients with LR. This finding could have serious impact on the treatment of patients with colorectal cancer. Further confirmation is required.

Feed efficiency, carcass characteristics, and sensory quality of lambs, with or without prolific ancestry, fed diets with different protein supplements.

Data were collected on 130 intact male lambs fed diets based on roughages supplemented with fish meal, soybean meal, or corn gluten-blood meal and slaughtered at 43 kg live weight. A nonsupplemented group served as a control. The lambs represented Romanov (R), Finnsheep (F), a new breed developed in Canada (DLS), Coopworth (C), and Suffolk (S), three first crosses of DLS with R, F, and Booroola Merino (B), and their backcrosses to DLS. Supplemented lambs consumed 16 to 22% less (P less than .05) silage than control lambs. Average daily gains of lambs fed fish meal (226 g) and corn gluten-blood meal (217 g) were higher and feed conversion ratio (4.99 and 5.11) lower than that of lambs fed soybean meal (189 g and 5.48) or control (186 g and 5.76) diets (P less than .05). The cost of feed per kilogram of gain or per kilogram of lean produced was similar in the four treatments but was between C $.23 and .65 cheaper in the protein-supplemented groups when the number of days to reach slaughter weight was considered. The effect of diet on carcass traits and meat quality were minimal. Meat of lambs fed the three protein supplements was less juicy than that of control lambs. With a few exceptions, most of the significant differences among genetic groups in growth, carcass, and sensory traits were mainly between prolific (R and F) and meat-type breeds (C, S, and DLS). Gain in weight was highest in S lambs (199 g/d), but F and R first crosses were the youngest at slaughter (196 and 198 d). The F lambs had higher dressing and kidney fat percentages than meat-type breeds. The DLS lambs had the largest longissimus muscle area (14.0 cm2), whereas C had the smallest (10.7 cm2). The B crosses had larger longissimus muscle area than R and F crosses. The R lambs had more lean and less fat in the 12th rib, whereas C lambs had the lowest lean and a high bone percentage. The toughest and the most tender roasts were those of R and B crossbred lambs, respectively. Roasts from F lambs had the most intense lamb flavor.

[Cephalic pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas: does pylorus preservation change morbidity and prognosis?]. / Duodénopancréatectomie céphalique pour adénocarcinome de la tête du pancréas: la conservation pylorique modifie-t-elle la morbidité et le pronostic?

STUDY AIM: To evaluate the influence of a pylorus-preserving on the morbidity and prognosis of patient with pancreaticoduodenectomy for adenocarcinoma of pancreas. PATIENTS AND METHODS: Between 1985 and 1999, 183 patients were operated on for pancreatic adenocarcinoma. Among them, 63 patients (40 men, mean age 63 years, range 41-77 years) had curative resection and were included in this retrospective study. They were classified according to the type of resection. In the group I, the procedure included a pylorus-preserving pancreaticoduodenectomy (n = 35). In the group II, the procedure included polar inferior gastrectomy (n = 28). The prognosis was compared. Parameters for comparison were rate of local recurrence, rate of metastatic evolution and duration of survival. RESULTS: The operative length and mortality rate (group I: 0%, group II: 3%), general (p = 0.37) and specific morbidity (p = 0.30), frequency of delayed gastric emptying were similar in the 2 groups (group I: 20%, group II: 35%, p = 0.88). The duration of naso-gastic aspiration was shorter in the group I (6 days vs 8, p = 0.01). The prognosis was the same in the 2 groups (metastasis: group I: 39%, group II: 56%, p = 0.12, local recurrence: group I: 58%, group II: 43%, p = 0.09, mean survival: group I: 18 months, group II: 19 months, p = 0.77). CONCLUSION: These results suggest that pylorus preserving pancreatoduodenectomy could be performed for patients with adenocarcinoma of the head of the pancreas and does not compromise survival.

[Hospital information systems ineffectiveness in costing ambulatory chemotherapy in pulmonary oncology]. / Insuffisance de la valorisation PMSI de la chimiothérapie ambulatoire en oncologie pulmonaire.

The real cost of medical consumption was compared with the proportion of medication consumption of (the) GHM n(o) 681 (homogeneous group of patients, chemotherapy for cancer in day care) in the French case mix system (PMSI). For those patients in our thoracic oncology unit (Sainte-Marguerite Hospital, Marseille, France), the real medication cost was calculated from prices paid by the hospital, then compared to the expected expenditures for the medication consumption of the GHM 681, i.e. 678 French francs (24.1% of the 225 ISA points (synthetic activity index)). Over a period of 2 months in 1998, 87 patients (mean age 63 +/- 11) had 194 chemotherapy sessions in day care, with multi-drug therapy in 38 cases. Vinorelbine or gemcitabine represented 81% of the single drug chemotherapy. In 84% of the single drug and 76% of the multi-drug chemotherapy, the real cost of medication consumption was above the allocated budget. The mean cost for single drug chemotherapy was 1722 FF and 2920 FF for multi-drug chemotherapy. The budget allocated by the PMSI shows a deficit in the most cases. To avoid a restriction in the use of some drugs, it appears that the French system of budget evaluation needs to be improved.

[Neurofibromatosis type 2. Preliminary results of gamma knife radiosurgery of vestibular schwannomas]. / Neurofibromatose de type 2. Résultats préliminaires de la radiochirurgie gamma knife des schwannomes vestibulaires.

BACKGROUND AND PURPOSE: The aim of this study was to assess tolerance and efficacy of gamma knife radiosurgery on vestibular schwannomas for patients affected with neurofibromatosis type 2. METHODS: Between July 1992 and December 1997, a gamma knife procedure was performed on 35 vestibular schwannomas affecting 27 patients (12 females and 15 males, mean age=27 years-old, range: 14-65). Fifteen of the patients were included in the Wishart subtype (severe form) and 12 patients in the Gardner subtype (mild form). This group of 27 patients represented 8,2% of the total group of vestibular schwannomas radiosurgically treated by our team. The mean tumor volume was 4,000 mm(3) (range: 400-14,400 mm(3)) and staging according to Koos classification was 9 stage 2 tumors (extension in the cerebellopontine angle), 19 stage 3 tumors (in contact with the brain stem or cerebellum) and 7 stage 4 tumors (compression of axial structures). The delivered mean marginal dose (50% isodose) was 13 Gy (range: 10-18 Gy). After the treatment, the mean clinical and radiological follow-up was 32 months (range: 6-70). RESULTS: Twenty six (74%) of the treated tumors were controlled by the treatment (15 stabilizations and 11 regressions of the tumor volume) at last follow-up. One microsurgical removal was required in a growing stage 4 tumor and in 2 cases of growing stage 3 tumors. Three post-radiosurgical facial nerve deficits (9%) were observed, 2 of them were transient. According to the Gardner and Robertson classification, classes I (good) and II (serviceable) hearing were preserved at last follow-up in 57% of the patients having the same hearing level prior to the gamma knife. CONCLUSIONS: Our experience confirms that tolerance of gamma knife radiosurgery compares favorably with microsurgery of bilateral vestibular schwannomas. This treatment should be restricted to small and medium growing tumors. Treatment strategy of neurofibromatosis type 2 patients should be planned by multidisciplinary experienced teams disposing of the whole armamentarium. A longer follow-up study is required to confirm the current results regarding the tumor control rate.

[Occlusions by colonic cancers: emergency treatment (62 cases)]. / Occlusions par cancers coliques: traitement en urgence (62 cas).

Sixty two patients (38 men, 24 women) were operated in emergency for colic occlusion from neoplasia. The mean age was 69.6 (+/- 12.71). Fourty four (70%) had an history of cardiovascular disease. Tumor resection has been possible in 95% of cases. The mortality was 24.19% in the first two months postoperatively and 11% between the second and the fourth month. The morbidity was 32.2% and the mean length of stay in hospital was 22 days (+/- 16.6). The morbidity was less in case of right hemicolectomy (17.3 days) than for left colic resections (26 days). The postoperative mortality was not correlated to age but to lost of weight more than 10 kg (p < 0.0001) and to a mean central preoperative temperature more than 37.5 degrees C (p < 0.002). Reducing the number of surgical procedures is beneficial in patients older than 70 years.

[Complications of colonic diverticulosis and emergency surgery. Prospective study of 56 cases]. / Complications de la diverticulose colique et chirurgie d'urgence. Etude prospective sur 56 cas.

Fifty six patients, 26 men (69.7 +/- 11.2 years) and 30 women (77.4 +/- 9.2 years) were admitted in the emergency unit for diverticulosis sigmoiditis. In 75% of cases an other pathology was associated. Excepted 11 extended peritonisis, 7 criterae of operation were required to operate on 17 men and 18 women (mean age = 73.7 +/- 12.5 years) in a delay less than 8 days. Reasons were: 12 occlusive forms, 9 peri-sigmoidis abcedations, 3 hemorrhages. Surgical procedures were: 11 Hartmann procedures, 21 resections with anatomosis of the sigmoid colon with 10 non protected and 3 subtotal colectomy. Postoperative mortality was been 11.4%. The global rate of complications was 28.5 and the mean hospital stay was 18.8 +/- 6.3 days. Application of operative criteriae is usefull to shorter significantly the delay of operation and then the length of evolution of the intraperitoneal infection site.

[Kidney traumatism in general surgery (65 cases)]. / Traumatismes du rein en chirurgie générale (65 cas).

From September 1989 to September 1994, 65 patients, 15 females and 50 males, with a mean age of 32 +/- 14 years were admitted in the emergency unit for renal trauma. In 38.5% of cases multiple trauma was present. Lesional mechanism was most frequently contusions (49.2%) and deceleration injuries (43.1%). Gross hematuria or microscopic hematuria were presents in 72.3% of cases. The sensibility of systematic abdominal echography was 100% in case of perirenal hematoma and 65% in case of parenchymatous lesions. Only 23 patients were operated (35.3%) because of low blood pressure. None secondary operation was necessary in abstention group. Global mortality was 7.7%. Postoperative morbidity was 20% and specific morbidity in abstention group was 10.7%.