Experimental study on a large animal model of a new thermoablation technique.

BACKGROUND: A novel technique of thermoablation, using a microtube to deliver pulses of hot water vapour, was tested on a large animal model in order to evaluate its efficacy and potential adverse effects. MATERIALS AND METHODS: The medical device consisted of a microtube extension connected to a hydropneumatic pump. Pulses of pure water were injected though the microtube where they were heated and delivered as vapour into the target zone. The method was tested on the liver of 12 healthy pigs, either during open surgery or percutaneously under ultrasounds. RESULTS: The technique was efficient and well-tolerated by the animals. Large volumes of necrotic tissue were created in a significantly short time compared to concurrent thermoablative techniques. CONCLUSION: Anticipating human application, this experimental study demonstrated a safe and efficient innovative thermoablation technique. The first human applications have been successfully performed and will be reported soon.

[Perforation of a jejunal diverticulum]. / Perforation d'un diverticule jéjunal.

An observation of jejunal diverticulum is reported by the authors. It concerned a woman 82 years old whose disease appeared as an acute white spread peritonitis complication. The delay brought to perform the operation made it impossible to save diseased. About that case is evoked the pathogeny of the diverticulum: congenital or acquired. In the case reported it was acquired, the proof resulting from the anatomy-pathology. The disease can appear under a chronicle form with a difficult diagnosis or under a single relevant form whose surgical treatment must be done without delay.

Mountain frostbite. Current trends in prognosis and treatment (from results concerning 1261 cases).

From an experience of a large number (1261) of cases of mountain frostbite, an attempt is made to explain its pathophysiological mechanisms and describe the different modalities which to now allow early prognosis to be made. Laser-Doppler, microwave thermography, nuclear magnetic resonance (31P spectroscopy) and bone scintigraphy (technetium 99) are some of the investigations which deserve a special attention. Treatment is discussed, which still appears to be limited to saving viable tissue, especially for severe frostbite lesions, the only ones which pose problems. Rapid rewarming is a keystone of therapy. The role of haemodilution, vasodilators, sympathetic blockade and surgery is also discussed.

[Mountain frostbite. A new approach to early prognosis. A study of 1,267 cases]. / Les gelures de montagne. Nouvelle approche du pronostic précoce. A propos de 1,267 cas.

Regarding an important series of mountain frostbite (1,267 cas), the authors try to explain the physiopathological mechanism. They expose the different methods that make possible nowadays an early prognosis. They set forth the treatment that seems still limited to save what can be spared; and this is valid for severe frostbite, the only ones to put problems. The quick warming up is the keystone of the treatment.

[Mountain frostbite (apropos of 1260 recorded cases)]. / Les gelures de montagne (à propos d'une statistique de 1260 cas).

Based on an important statistic of mountain frostbite (1260 cases), the authors try to explain the underlying physiopathological mechanism which remains largely unknown. An early prognosis may nowadays be improved by several diagnostic tools whose efficiency is reviewed. Difficult problems arise with severe frostbite only. In those cases, the treatment as such seems still limited to saving what has been spared. In any case, a quick warming up is the keystone of the treatment.

[Severe frostbites of the limbs. Apropos of 4 cases. A new approach of early prognosis]. / Gelure grave des extrémités. A propos de quatre cas. Nouvelle approche du pronostic précoce.

The statistics of frostbites of the Chamonix Hospital surgical service include 1232 cases, 587 of them having been treated at the hospital. As regard four cases of severe frostbites having led to an amputation, the author reviews the complementary examinations that make possible an early prognosis. Among them, the bony scintigraphy must be privileged. It is nowadays a routine examination as it is technically easy and not difficult to interpret. Two spectroscopic examinations of living cells in NMR are reported, however no definitive conclusions could be reacted. A certain number of fundamental notions are assorted regarding the validity of the physiological mechanism what enables to reaffirm the three pillars of the treatment that must be often reduced to the simple limitation of the lesions. Two examinations show that in 1991, infection of frostbites can be always so redoutable.

[Hang-gliding accidents in high mountains. Apropos of 200 cases]. / Les accidents de parapente en haute montagne. A propos de 200 cas.

A review of 200 cases of "paragliding" accidents in high mountain areas has been completed. The first flights have been murderous, a thesis written in 1987 in Grenoble showing seven dead out of 97 casualties. Since then the statistics seen to be improving as a consequence of the setting of regulations and the establishment of "paragliding" schools. The more frequent accidents happen on landing: in 70% of the cases fractures of the "tibiotarsienne", the wrist and the spinal column prevail. They happen to young adults between 20 and 40 years old, with a variable experience. Preventive measures consist in a greater prudence, a good physical condition and a precise aerological knowledge. The adepts of this sport have understood that wearing a helmet and appropriate shoes could reduce the gravity of the accidents. "Paragliding" if not a dangerous sport is certainly a risky one.

[Lightning injuries in high mountain areas. Report of 29 cases]. / Les accidents de fulguration en haute-montagne. A propos de 29 cas.

Lightning, usually scarce, is a frequent phenomenon in high mountains. Due to our location at the foot of the Mont-Blanc, we have been able to examine twenty nine cases of people struck by lightning in the Chamonix Hospital. Lightning that has interested people since old times is the result of complex meteorological phenomenons, able to deliver a huge instant power. Several types of lightning have been described. They give different sorts of injuries; the most frequent affect the brain, the heart and the skin. The analysis of the results of seventeen victims admitted at the hospital does not allow to conclude to a clinical and biological specificity of the lightning stricken in high mountains. It makes it however possible to determine precisely the clinical disorders and the features of the injured and to emphasize the part due to the high mountains and consider the non specific therapeutic to set to work as soon as possible.

[Frostbite: findings May 1990]. / Les gelures: mise au point mai 1990.

Frostbites are a frequent pathology in mountain sports; we treat 80 cases per years in Chamonix. Usually due to a bad equipment, they are favoured by humidity, wind, the high altitude polycythemia and dehydration. Physiopathology associates a physic phenomenon (freezing) with a vasomotor response. Diagnosis is obvious; the forecast rests on the bone scintigraphy and treatment combines fast warm up, vasodilators, hemodilution and late surgery. Only 8% of our patients have amputations. The best treatment is prevention.

[NMR spectrometry in vivo with a resistive magnet at 1,2 T]. / Spectrométrie RMN in vivo avec un aimant résistif à 1,2 T.

A resistive magnet, operating at 1.2 T, intended to magnetic resonance spectroscopy in man was set up and evaluated in the hospital of Chamonix. Drusch S.A. in collaboration with Institut d' Electronique fondamentale built the system with the following characteristics: weight: 12 t, pole diameter: 55 cm, distance between coils: 36 cm. Cooling the magnet was provided by water flowing at 50 l/min. The magnetic field homogeneity was 3 X 10(-7) in a 60 mm diameter sphere. Stability was regulated at +/- 1 mGs. Five correcting circuits were used (X, Y, Z, Z2, XY). For experiments in man useful window was 120 X 20 cm and allowed measurements in brain and limbs. With this type of magnet, 1H, 31P and 23Na NMR spectra equalled in quality those obtained with superconducting magnets which work at a very higher cost.

[Treatment of frostbites. Analysis of results in twenty patients with buflomedil chlorhydrate (author's transl)]. / Le traitement des gelures de montagne. Analyse des résultats obtenus sur vingt gelés par le chlorhydrate de buflomedil.

Twenty cases of mountain frostbites of various degrees are presented, showing that buflomedil hydrochloride allows an improvement of the usual treatment of frostbites. Two protocols were used: 1) in 8 patients, after the usual treatment (bath at 38 degrees C, dextran perfusion, heparintherapy, antibiotherapy), buflomedil hydrochlorhydrate was administered by perfusion of 8 vials/day, during 10 days; 2) in 12 patients, buflomedil was injected directly by intravenous route on their arrival in the Emergency room. When the injection is given early, a potentiation of the effects of the warm bath is observed, and in two cases, this therapy has perhaps allowed to avoid the amputation.