[Decompression sickness accident management in remote areas. Use of immediate in-water recompression therapy. Review and elaboration of a new protocol targeted for a mission at Clipperton atoll]. / Gestion d'un accident de plongée en situation d'isolement. Intérêt de la recompression thérapeutique par immersion. Revue et proposition d'un nouveau protocole à l'occasion d'une mission sur l'atoll de Clipperton.

In-Water Recompression (IWR) is defined as a treatment of decompression sickness by immediate underwater recompression after the onset of symptoms in remote areas where hyperbaric chambers are not available. At least three methods of IWR have been published. They used pure oxygen breathing for prolonged periods of time at a depth of 9 m. IWR effectiveness in comparison with standard recompression techniques has not been assessed. IWR should be used in remote localities as an immediate measure to stop the evolution of decompression illness before evacuating the victim for subsequent treatment to the nearest hyperbaric facility. Resulting from environmental conditions, the risks of drowning and hypothermia are the most often quoted, pure oxygen breathing at 9 m can also expose to acute oxygen toxicity. The objectives of this work are: first, to examine existing published methods of IWR; second, to propose a new method of IWR. All published methods of IWR involve victim returning underwater for a long period of time. But dehydration due to a long period of immersion can worsen symptoms of decompression illness and acute oxygen toxicity is also related to the duration of the exposition. In response to these considerations we developed a shorter method of conducting IWR specifically targeted for a diving mission at Clipperton atoll in the Northern Pacific Ocean.

[The role of surgery in primary gastric non-Hodgkin's malignant lymphoma]. / Place de la chirurgie dans les lymphomes malins non Hodgkiniens gastriques primitifs (L.M.G.P.).

A total of 15 cases of primary gastric non-Hodgkin's malignant lymphoma (PGML) seen between 1974 and 1985 were reviewed, and data obtained combined with reports in the literature, to define the place of surgery in this affection becoming the monopoly of chemotherapists. The indication for surgery is indisputable when the diagnosis is in doubt, and justified for ulcerated and preperforating forms and in extirpable tumoral forms of loco malignancy. It should be avoided in high grade PGML unless the operation does not delay chemotherapy. Total gastrectomy should not be performed by principle but by necessity. Abdominal exploration should include lymph node and liver biopsies. An effective total care of these patients requires close cooperation between medical and surgical teams.