[The central role of the hospital director in the application of the white plan]. / Le rôle central du directeur d'établissement dans l'application du plan blanc.

If the Bégin military teaching hospital, a level 1 health facility, managed to maintain its position during the covid-19 crisis, it is thanks to the total commitment of its staff. To face the crisis, the hospital director ensured a very good level of preparedness and mobilisation of the teams.

Vertical distribution of aerosols in dust storms during the Arctic winter.

High Latitude Dust (HLD) contributes 5% to the global dust budget, but HLD measurements are sparse. Dust observations from Iceland provide dust aerosol distributions during the Arctic winter for the first time, profiling dust storms as well as clean air conditions. Five winter dust storms were captured during harsh conditions. Mean number concentrations during the non-dust flights were <5 particles cm-3 for the particles 0.2-100 µm in diameter and >40 particles cm-3 during dust storms. A moderate dust storm with >250 particles cm-3 (2 km altitude) was captured on 10th January 2016 as a result of sediments suspended from glacial outburst flood Skaftahlaup in 2015. Similar concentrations were reported previously in the Saharan air layer. Detected particle sizes were up to 20 µm close to the surface, up to 10 µm at 900 m altitude, up to 5 µm at 5 km altitude, and submicron at altitudes >6 km. Dust sources in the Arctic are active during the winter and produce large amounts of particulate matter dispersed over long distances and high altitudes. HLD contributes to Arctic air pollution and has the potential to influence ice nucleation in mixed-phase clouds and Arctic amplification.

Vascular complications following total hip arthroplasty: a case study and a review of the literature.

Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA.

[Subintimal angioplasty and diabetic foot revascularisation]. / Revascularisation du pied diabétique.

Diabetic wounds foot are responsible for 5-10% minor or major amputation in France. In fact, amputation risk of lower limbs is 15-30% higher for diabetic patients. University of Texas classification (UT) is the reference for diabetic foot wound. It distinguish non ischemic and ischemic wound with more amputation. If ischaemia is combined, revascularization may be considered for salvage of the limb. Some revascularization techniques are well known: as surgical by-pass, angioplasty with or without stent, or hybrid procedures with the both. Subintimal angioplasty is a more recent endovascular technique, in assessment for old patients who are believed to be unsuitable candidates for conventional by-pass or angioplasty.

[Atypical claudication and functional popliteal entrapment]. / Une claudication atypique par piège poplité fonctionnel.

INTRODUCTION: Popliteal artery entrapment syndrome is infrequent. One form less well recognized has no anatomic abnormality. CASE REPORT: A 22-year old man, with a medical history of chronic compartment syndrome treated surgically by aponeurectomy, had developed intermittent claudication of both legs with plantar paresthesia. Active plantar flexion of the ankle reduced distal pulses and doppler ultrasound waveforms. Popliteal artery entrapment syndrome was suspected and was confirmed by dynamic angiography. Because no arterial ou muscular abnormalities were found, we diagnosed a functional popliteal entrapment syndrome. Surgical treatment permitted rapid functional improvement. DISCUSSION: Positional occlusion of the popliteal artery is a normal physiologic variant that may become pathologic with muscle overuse or traumatic injury. It causes neuromuscular claudication by compressing the neurovascular bundle at the level of the soleal sling. Diagnosis is based on dynamic color-flow duplex imaging and magnetic resonance angiography. Surgical treatment is indicated only for symptomatic patients and consists of fasciotomy, resecting the compressing structures with a posterior or medial approach.