Vulnérologie: un néologisme pour magnifier le concept «plaies et cicatrisation¼.

Wound healing, though probably the most critical aspect of essential medical and surgical care, has been neglected for a long time. With the tremendous surge over the last two decades in basic research and in new techniques, wound healing is emerging more and more as a well-defined medical entity transcending existing specialties and subdivisions. Specialists working on the same subject must be known by a common name. There is a need to fill the gap in our current medical nomenclature in order to define all those interested in this subject. With etymologic, semantic and botanical arguments, Vulnerology seems to be an appropriate neologism. It will unite in the same group people who share a common interest and way of thinking to promote the concept of wound healing.

Brûlologie et médecine légale: les victimes d'incendie.

During a judicial inquiry, the forensic doctor is frequently required to examine the hospitalized fire victim. He has to produce a certificate on the burns, defining their origin, seriousness and prognosis. The expert assessment of serious burn victims consists in an overall evaluation of functional and psychological sequelae, and can be conducted only after the long period of treatment needed for them to heal. The expert must know the forensic rules concerning the specific features of sequelae that follow a cutaneous burn injury. The forensic doctor can intervene where a body is discovered, and the aim of the autopsy is to check if burns were the cause of death. The most common lesions observed are serious thermal burns and they are frequently associated with inhalation of fumes. Often the body is carbonized to conceal a homicide therefore it is crucial that postmortem results are compared with the police investigation data. Due to modifications to the body brought about by fire and charring, a specific protocol for identification is required, especially in the event of a disaster.

Exhaust emissions of volatile organic compounds of powered two-wheelers: effect of cold start and vehicle speed. Contribution to greenhouse effect and tropospheric ozone formation.

Powered two-wheeler (PTW) vehicles complying with recent European type approval standards (stages Euro 2 and Euro 3) were tested on chassis dynamometer in order to measure exhaust emissions of about 25 volatile organic compounds (VOCs) in the range C1-C7, including carcinogenic compounds as benzene and 1,3-butadiene. The fleet consists of a moped (engine capacity ≤ 50 cm(3)) and three fuel injection motorcycles of different engine capacities (150, 300 and 400 cm(3)). Different driving conditions were tested (US FPT cycle, constant speed). Due to the poor control of the combustion and catalyst efficiency, moped is the highest pollutant emitter. In fact, fuel injection strategy and three way catalyst with lambda sensor are able to reduce VOC motorcycles' emission of about one order of magnitude with respect to moped. Cold start effect, that is crucial for the assessment of actual emission of PTWs in urban areas, was significant: 30-51% of extra emission for methane. In the investigated speed range, moped showed a significant maximum of VOC emission factor at minimum speed (10 km/h) and a slightly decreasing trend from 20 to 60 km/h; motorcycles showed on the average a less significant peak at 10 km/h, a minimum at 30-40 km/h and then an increasing trend with a maximum emission factor at 90 km/h. Carcinogenic VOCs show the same pattern of total VOCs. Ozone Formation Potential (OFP) was estimated by using Maximum Incremental Reactivity scale. The greatest contribution to tropospheric ozone formation comes from alkenes group which account for 50-80% to the total OFP. VOC contribution effect on greenhouse effect is negligible with respect to CO2 emitted.

A multi-approach monitoring of particulate matter, metals and PAHs in an urban street canyon.

For the first time until now, the results from a prediction model (Atmospheric Dispersion Modelling System (ADMS)-Road) of pollutant dispersion in a street canyon were compared to the results obtained from biomonitors. In particular, the instrumental monitoring of particulate matter (PM10) and the biomonitoring of 14 polycyclic aromatic hydrocarbons (PAHs) and 11 metals by Quercus ilex leaves and Hypnum cupressiforme moss bags, acting as long- and short-term accumulators, respectively, were carried out. For both PAHs and metals, similar bioaccumulation trends were observed, with higher concentrations in biomonitors exposed at the leeward canyon side, affected by primary air vortex. The major pollutant accumulation at the leeward side was also predicted by the ADMS-Road model, on the basis of the prevailing wind direction that determines different exposure of the street canyon sides to pollutants emitted by vehicular traffic. A clear vertical (3, 6 and 9 m) distribution gradient of pollutants was not observed, so that both the model and biomonitoring results suggested that local air turbulences in the street canyon could contribute to uniform pollutant distribution at different heights.

Bioethanol-gasoline fuel blends: exhaust emissions and morphological characterization of particulate from a moped engine.

This study was aimed at evaluating the effects of gasoline-ethanol blends on the exhaust emissions in a catalyst-equipped four-stroke moped engine. The ethanol was blended with unleaded gasoline in at percentages (10, 15, and 20% v/v). The regulated pollutants and the particulate matter emissions were evaluated over the European ECE R47 driving cycle on the chassis dynamometer bench. Particulate matter was characterized in terms of total mass collected on filters and total number ofparticles in the range 7 nm-10 microm measured by electrical low-pressure impactor (ELPI). In addition, particle-phase polycyclic aromatic hydrocarbons (PAHs) emissions were evaluated to assess the health impact of the emitted particulate. Finally, an accurate morphological analysis was performed on the particulate by high-resolution transmission electron microscope (TEM) equipped with a digital image-processing/data-acquisition system. In general, CO emission reductions of 60-70% were obtained with 15 and 20% v/v ethanol blends, while the ethanol use did not reduce hydrocarbon (HC) and NOx emissions. No evident effect of ethanol on the particulate mass emissions and associated PAHs emissions was observed. Twenty-one PAHs were quantified in the particulate phase with emissions ranging from 26 to 35 microg/km and benzo[a]pyrene equivalent (BaPeq) emission factors from 2.2 to 4.1 microg/km. Both particulate matter and associated PAHs with higher carcinogenic risk were mainly emitted in the submicrometer size range (<0.1 microm). On the basis of the TEM observations, no relevant effect of the ethanol use on the particulate morphology was evidenced, showing aggregates composed ofprimary particles with mean diameters in the range 17.5-32.5 nm.

[Medico-legal assessment in the sequelae of burns (1st part)]. / Évaluation médicolégale des sequelles de brulures (1re partie).

The assessment of physical injury in after-effects of burns is very specific. Indeed, the evolution of burn scars is particular compared to the scarring process in general. The expert needs to know these specific aspects in order to objectively assess the after-effects due to burns, in order to compensate for the loss of autonomy in major burn victims. The assessment has to analyze all the effects, functional and aesthetic, of the after-effects due to burns and has to particularly specify: the mending, which can never be set before one year, the pressure test allowing to check the complete maturation of the scars; the functional disability which results from skin retractions (due to after-effects) on the limbs mobility but which also must consider the burnt skin surface; the aesthetic damage, often important, with a discrimination between hypertrophic and keloid scars; the suffering, always significant in view of specialized and prolonged therapeutics; the sexual damage, often unrecognized in this type of injured people.

[General principles of burn reconstruction]. / Principes généraux de la chirurgie reconstructrice des séquelles de brûlures.

The aims of burn reconstruction should be to preserve, restore, and maintain function and appearance so the patient can recover a social life. Reconstruction surgery is delayed until the scar tissue has fully matured; it occurs generally by 9 to 12 months or more (merits of vitro-pressure test). Exception in presence of severe contracture (growth disturbance, unstable scars, corneal exposure with ectropion, severe microstomia) Occupational and physical therapy, scar management, compressive techniques, psychotherapy are all integral components of burn rehabilitation, but the place of plastic surgeon is fundamental all along the process.

Estudio comparativo de la estructura del bacterioplancton en aguas del Mar Argentino mediante el método de pirosecuenciación 454 tag / A comparative study of bacterioplankton structure in Argentinian Sea waters by the 454 - tag pyrosequencing method

El presente estudio brinda la primera información sobre diversidad y abundancia de las comunidades microbianas en dos ambientes del Mar Argentino obtenida mediante la técnica de pirosecuenciación tag ribosomal 454. Dentro del dominio Bacteria, se observaron más de 4 600 secuencias únicas a partir de 36 188 amplicones de tags y se identificaron 280 filotipos. Además, se detectaron cerca de 2 700 secuencias únicas a partir de más de 47 700 tags pertenecientes al dominio Archaea, lo que definió sólo 5 filotipos diferentes. La distancia de Jaccard presentó valores de 0,6 para bacterias y de 0,2 para arqueas, esto indica mayor diferencia entre las bacterias en los dos sitios. En el ambiente marino los filotipos más dominantes fueron Bacteroidetes Flavobacteriaceae, Proteobacteria Gammaproteobacteria, Proteobacteria Rhodobacteraceae y Proteobacteria Rickettsiales SAR11, mientras que en el estuario predominaron Pseudoalteromonadaceae Pseudoalteromonas, Proteobacteria Gammaproteobacteria, Proteobacteria Shewanella y Proteobacteria Rickettsiales SAR11. Los 2 filotipos de arqueas encontrados en mayor proporción fueron Archaea Euryarchaeota y Archaea Crenarchaeota. Las secuencias tag más numerosas representaron taxa caracterizados previamente, aunque también se halló un elevado número de filotipos de gran diversidad y de baja abundancia, que forman parte de la denominada "biosfera rara", aún no explorada, que pueden tener un papel ecológico crucial.

The present study provides the first information about diversity and abundance of microbial communities in two environments of the Argentinian Sea by the 454 - tag pyrosequencing technique. We observed more than 4,600 unique bacterial sequences from 36,188 tag amplicons, forming 280 phylotypes. In addition, nearly 2,700 unique sequences from more than 47,700 tags identified as Archaea, defined only 5 different phylotypes. The Jaccard distance (0.6 for Bacteria and 0.2 for Archaea) indicated higher differences among Bacteria rather than among Archaea in both studied sites. The dominant phylotypes in marine environment were Bacteroidetes Flavobacteriaceae, Proteobacteria Gammaproteobacteria, Proteobacteria Rhodobacteraceae and Proteobacteria Rickettsiales SAR11; and Pseudoalteromonadaceae Pseudoalteromonas, Proteobacteria Gammaproteobacteria, Proteobacteria Shewanella, Proteobacteria Rickettsiales SAR11 in the estuary sampling site. Archaea Euryarchaeota and Archaea Crenarchaeota were the major archaeal phylotypes found. The most abundant tag sequences included previously characterized taxa, although we also retrieved a large number of highly diverse, low-abundant phylotypes which constitute a largely unexplored "rare" biosphere. These microorganisms could have a crucial ecological role.

[A comparative study of bacterioplankton structure in Argentinian Sea waters by the 454-tag pyrosequencing method]. / Estudio comparativo de la estructura del bacterioplancton en aguas del Mar Argentino mediante el método de pirosecuenciación 454 tag.

The present study provides the first information about diversity and abundance of microbial communities in two environments of the Argentinian Sea by the 454 - tag pyrosequencing technique. We observed more than 4,600 unique bacterial sequences from 36,188 tag amplicons, forming 280 phylotypes. In addition, nearly 2,700 unique sequences from more than 47,700 tags identified as Archaea, defined only 5 different phylotypes. The Jaccard distance (0.6 for Bacteria and 0.2 for Archaea) indicated higher differences among Bacteria rather than among Archaea in both studied sites. The dominant phylotypes in marine environment were Bacteroidetes Flavobacteriaceae, Proteobacteria Gammaproteobacteria, Proteobacteria Rhodobacteraceae and Proteobacteria Rickettsiales SAR11; and Pseudoalteromonadaceae Pseudoalteromonas, Proteobacteria Gammaproteobacteria, Proteobacteria Shewanella, Proteobacteria Rickettsiales SAR11 in the estuary sampling site. Archaea Euryarchaeota and Archaea Crenarchaeota were the major archaeal phylotypes found. The most abundant tag sequences included previously characterized taxa, although we also retrieved a large number of highly diverse, low-abundant phylotypes which constitute a largely unexplored "rare" biosphere. These microorganisms could have a crucial ecological role.

Degradation of linear alkylbenzene sulfonate by a bacterial consortium isolated from the aquatic environment of Argentina.

AIMS: To isolate and identify linear alkylbenzene sulfonate (LAS)-degrading bacteria from Río de la Plata and adjacent waters, and to assay their degradation capability as a consortium and as single organisms. METHODS AND RESULTS: A consortium consisting of four bacterial strains: Aeromonas caviae (two strains), Pseudomonas alcaliphila and Vibrio sp. was identified by 16S rRNA analysis. Isolates grown as a consortium produced higher biomass from LAS and CO(2) release (mineralization) than individual cultures, and degraded 86% of LAS (20 mg l(-1)), whereas pure strains degraded between 21% and 60%. Bacterial desulfonation from LAS was evidenced in the consortium and A. caviae strains. A complete disappearance of LAS (10 mg l(-1)) was accomplished, and LAS levels of 50 and 100 mg l(-1) led to a pronounced decrease in the biodegradation extent and inhibition of culture growth. CONCLUSIONS: A bacterial consortium capable of complete LAS degradation was isolated from the Río de la Plata and adjacent waters. This consortium was more efficient for LAS degradation than individual cultures, and was sensitive to high LAS concentrations. SIGNIFICANCE AND IMPACT OF THE STUDY: The autochthonous consortium with high effectiveness on LAS biodegradation is a useful tool for LAS depletion from these polluted ecosystems.

Environment and virulence factors of Vibrio cholerae strains isolated in Argentina.

AIMS: To determine the presence of Vibrio cholerae in different areas of Argentina in three sample types, to determine the composition of planktonic communities in areas at which this pathogen was detected and to characterize the virulence properties and antimicrobial resistance of the recovered environmental isolates. METHODS AND RESULTS: Water and plankton samples were collected in marine, brackish and freshwater environments. Vibrio cholerae non-O1, non-O139 was isolated in 36.1% of the samples analysed. The micro-organism was detected in freshwater but not in marine or brackish samples. No relationship was found between isolation of V. cholerae and presence of any species of plankton. All the isolates presented very similar virulence profiles by PCR, lacking ctxA and tcpA El Tor and containing hlyA (98.7%), rtxA (99.0%), toxR (98.7%) and stn-sto (1.9%). Resistance to ampicillin was found in both Tucumán (21%) and Buenos Aires isolates (45%). CONCLUSIONS: We identified two geographic areas in Argentina where V. cholerae was present: freshwaters of the rivers from Tucumán and the Río de la Plata. SIGNIFICANCE AND IMPACT OF THE STUDY: The identification of V. cholerae strains in the environment, carrying both virulence factors and resistance to antimicrobial agents, highlight the need for a continuous and active surveillance of this pathogen.

Second-degree burns: a comparative, multicenter, randomized trial of hyaluronic acid plus silver sulfadiazine vs. silver sulfadiazine alone.

AIMS: This multicenter, multinational, randomized, double-blind, controlled, parallel-group study, was designed to assess the efficacy and safety of a fixed combination topical medicinal product, containing 0.2% hyaluronic acid and 1% silver sulfadiazine (HA-SSD) (Connettivina Plus cream) versus 1% silver sulfadiazine cream alone (SSD), in the treatment of second-degree burns. METHODS: 111 adult patients (age 18-75 years) of both sexes, with IIa-degree (superficial) and IIb-degree (deep dermal) burns, were randomized to receive HA-SSD or SSD. Treatments (approximately 5 g/100 cm2) were applied once a day until the wounds healed, but for no longer than 4 weeks. Burns had to have occurred within 48 hours from the start of treatment, be caused by thermal injury, and be confined to the trunk and/or upper and lower extremities. RESULTS: Results showed that both the fixed combination HA-SSD, and SSD alone, were effective and well tolerated topical agents for the treatment of second-degree burns. All burns were healed except in one patient treated with SSD. It was also observed that the fixed combination HA-SSD caused a significantly more rapid re-epithelialization of burns, i.e. a shorter time to healing, than SSD alone. The difference recorded--4.5 days--was statistically significant (p = 0.0073). CONCLUSION: The observed shorter time to healing caused by the fixed combination is clinically relevant and further demonstrates the wound healing activity of HA.

[Treatment of facial lesions in Parry-Romberg and Barraquer-Simons syndromes: report of 12 clinical cases]. / Traitement des lésions faciales dans les syndromes de Parry-Romberg et de Barraquer-Simons: à propos de 12 cas cliniques.

The authors report their personal experience in surgical treatment of facial atrophies. The series present two types of facial atrophy: Parry-Romberg syndrome and Barraquer-Simons syndrome. After reviewing the etiology, pathogenesis and clinical features of these two entities, the authors describe their series of 12 patients: six presenting Parry-Romberg unilateral facial atrophy, six presenting from Barraquer-Simons bilateral facial atrophy. After a review of the literature, they draw conclusions about surgical repair techniques used (free or pedicled flaps, alloplastic grafts, lipofilling) and compare them with those reported in the literature.

Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience.

OBJECTIVE: To compare various techniques for the treatment of pilonidal sinus. DESIGN: Retrospective study SETTING: University Hospital of Toulouse, France. SUBJECTS: 246 consecutive patients who presented between 1979 and 1996. The male:female ratio was 2:1, and the mean age 26 years (range 18-69). INTERVENTIONS: 218 one or two stage excision and rotation skin flaps, and 28 simple incisions. RESULTS: 16 sinuses recurred, and no flaps necrosed. CONCLUSION: Excision and rotation skin flaps offers an effective and elegant alternative to the more classic operations for pilonidal sinus as it causes less postoperative pain and shortens convalescence.

Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry.

A variety of breast deformities of differing appearances can be grouped together within an extensive syndrome that is characterized by anomalies of the breast base and preferentially involves the lower quadrants. Tuberous breasts are the most typical, but not the only, form of the deformity. The authors studied a series of 37 patients who had breast surgery, and they used a classification of three types: I, II, and III (in increasing order of severity). In type I breasts (minor form), only the lower medial quadrant is deficient; in type II breasts, both lower quadrants are deficient; and in type III breasts, all four quadrants are deficient. The study showed a predominance of minor forms (54 percent of breasts operated on) and of combinations including at least one minor form (81 percent of patients). Seventy percent of women had a breast asymmetry of more than 100 g. Only 27 percent of breasts operated on were hypotrophic, 45 percent were of normal volume, and 28 percent were hypertrophic. The authors propose a procedure to treat the minor forms of the deformity, using a mammaplasty with a superior pedicle and a lower lateral dermoglandular flap to fill the deficient lower medial quadrant. They define the indications of the classic techniques according to the type of deformity and stress the frequent need for secondary revision.

["Saphenous vascular loop" technique in the treatment of lower limb defects. Report of five cases]. / Technique de la "boucle vasculaire saphène" dans le traitement des pertes de substance du membre inférieur. A propos de 5 cas.

Five patients with high energy trauma of the lower limb with tissue defect located in the knee or the proximal third of the leg underwent reconstruction with a free latissimus dorsi flap. This flap was connected to a vascular saphenous loop which initially creates an arterioveous shunt between proximal femoral vessels. This was performed in a single operation with two teams of surgeons. This technique was chosen because a healthy recipient pedicle was not available in the vicinity of the defect. Application of vein grafts is not the usual procedure but there are situations in which it becomes necessary. Our aim in this paper is to discuss these situations, to describe the technique used in our Hospital and to analyze the advantages and disadvantages of a one or two-stage operation.

A predetermined design for easier aesthetic abdominoplasty.

The authors have presented a predetermined design of cutaneous resection for abdominoplasty without relocation of the umbilicus. The design is characterized by two lateral tips, pointing upward, and a central dome. The upper and lower edges of the cutaneous incision are of the same length, which prevents puckers and allows optimal evolution of the scar. The median cutaneous resection removes the horizontal base of the triangular area of pubic hair, producing a lower final scar and giving the mons pubis a more youthful appearance. The lateral cutaneous resections allow transverse redraping of the abdominal skin, and the oblique scars, placed in the natural folds, are easily concealed even under brief attire. Unlike individual resection techniques that require practice and experience, this technique is perfectly codified and can be carried out by less experienced surgeons.

[Severe cutaneous necrosis after ultrasound lipolysis. Medicolegal aspects and review]. / Nécrose cutanée dramatique après lipolyse ultrasonique. Aspect médico-légal et mise au point.

The authors report the case of a young patient who developed extensive skin necrosis after ultrasound liposuction of the medial surface of the thigh. These lesions required excision, split-skin graft and installation of an expansion prosthesis. The medicolegal aspects of this case are discussed, in particular the responsibility of the doctor who performed this damaging procedure, from three points of view: damage, fault, causality. In this case, the damage corresponded to necrosis which can be due to a chemical, infectious or thermal mechanism. It is responsible for serious damages due to the number of operations, the length of hospital stay, immobilization, rehabilitation and the time off work. The aesthetic damage, the pretium doloris, and the inconvenience are certainly considerable, but was there fault in this case? Fault by clumsiness if the equipment was used abnormally; fault by negligence or imprudence when the equipment was not approved or when the operator was not a qualified physician, submitting his patient to undue risks. The causality is envisaged in the case of chemonecrosis and burns. It would be strongly presumed in a civil procedure in case of non-approved equipment. The authors are in favour of a hypothesis of a burn and review the current state of ultrasound liposuction, which was the subject of an intense media campaign several years ago.

[Imaging of abdominal wall eventration: role and value of x-ray computed tomography]. / Imagerie de la paroi éventrée: place et intérêt de la tomodensitométrie.

The role of imaging in preoperative investigation of incisional hernia was studied in a series of 332 operated patients. CT scan (220 patients) remains the reference investigation. Magnetic resonance imaging (8 patients) does not provide any supplementary information at the present time. The classical features of median and lateral incisional hernia are described and the importance of evaluation of the elasticity and strength of the abdominal wall is stressed. In the authors' experience, this evaluation has implications for pre- and intraoperative strategy.