[Surgeons can learn from pilots: human factors in surgery]. / Les chirurgiens peuvent apprendre des pilotes: place du facteur humain en chirurgie.

Human factors (HF) study is mandatory to get air transport pilot licences. In aviation, crew resource management (CRM) and declaration of adverse events (feedback) result in improving of air safety. Air missions and surgical procedures have similarities. Bridging the gap is tempting, despite severe warnings against simplistic adaptation. Putting HF theory into surgical practice: how to? Educational principles derived from CRM improve professional attitudes of a team. We propose to translate concepts of CRM to clinical teams. CRM training applying in surgery could allow the work environment to be restructured to reduce human error. Feedback: in aviation, the Bureau of Flight Safety deals with investigations for air events. Pilots, air traffic controllers can anonymously declare nuisance, resulting in a feedback for the whole air force. Adverse events are analysed. Usually, multilevel problems are found, rather than the only responsibility of the last operator. Understanding the mechanisms of human failure finally improves safety. In surgery, CRM and feedback would probably be helpful. Anyway, it requires time; people have to change their mind. Nevertheless people such as fighter pilots, who were very unwilling at the beginning, now consider HF as a cornerstone for security. But it is difficult to estimate the extent of HF-related morbidity and mortality. We propose as a first step to consider CRM and feedback in surgical procedure. HF deals with the mechanisms of human errors and the ways to improve safety and probably improve the surgical team's efficacy.

[Foreign body perforation of the thoracic esophagus]. / Perforations de l'oesophage thoracique par corps étranger.

BACKGROUND: Esophageal perforation due to foreign body (FB) ingestion is an unusual occurrence. This study aims to define diagnostic difficulties of esophageal perforation by FB. PATIENTS AND METHODS: A chart review of patients on our service with FB esophageal perforation was carried out. Diagnosis of perforation was made by CT scan and/or esophagoscopy. Surgery was indicated when a FB could not be removed endoscopically or on a case-by-case basis according to clinical/laboratory, radiologic, and/or endoscopic findings. RESULTS: Seven patients (age range: 27 to 80 years) were admitted for esophageal FB perforation. All patients presented with dysphagia. Two patients presented with signs of sepsis more than 24 hours after FB ingestion. Perforation was diagnosed at initial evaluation in five cases (three by endoscopy, two by CT) and after FB extraction in two cases. Six patients underwent surgery (suture repair: n=4; esophageal exclusion: n=1; mediastinal drainage: n=1). Five surgeries were performed at the initial diagnosis and one after failure of medical management. Mortality was zero; one patient developed esophageal fistula. CONCLUSION: Diagnosis of FB esophageal perforation is difficult and is delayed in up to a quarter of patients. The perforation can be due to the FB itself or may be incurred during endoscopic extraction. Both CT and endoscopy are necessary for diagnosis and treatment. Most patients require surgical intervention.

[Post-amoxicilline neutropenic rectitis in an immunocompetent patient: a case report]. / Rectite neutropénique post-amoxicilline chez un patient immunocompétent: à propos d'un cas.

We report a 38-year-old immunocompetent patient who presented with a neutropenic rectitis after a treatment by amoxicillin for nasopharyngitis. Neutropenic colitis is a digestive wall inflammation, preferentially localized in the ileo-caecal area and the right colon, which leads to necrosis and sepsis, and usually occurs in neutropenic patients treated by chemotherapy with an incidence of 6%. It is a serious and often lethal disease. The treatment is supportive, and surgery is limited to the occurrence of complications (perforation, bleeding). Neutropenic colitis occurring in a rectal location after antibiotic therapy in an immunocompetent patient has been rarely described.

[Acute hepatic failure as the presenting manifestation of a metastatic lung carcinoma to liver]. / Insuffisance hépatique aiguë révélatrice d'un carcinome pulmonaire avec métastases hépatiques.

Liver failure as a result of neoplasia is a rare event before the terminal stage of the illness. We report a 66-year-old man who presented with clinical features of acute liver failure as the initial manifestation of a small-cell lung carcinoma. Liver was enlarged without ascitis. Abdominal CT-scan revealed a massive hepatomegaly with multiple low-density wedge-shaped lesions. The patient developed stage 3 hepatic encephalopathy and died on day 4. The diagnosis was obtained with post-mortem study. A Medline search of acute liver failure due to small-cell carcinoma identified only 17 cases already published, with a universally poor prognosis.

[The Main Gate Syndrome: a new format in mass-casualty victim "surge" management?]. / Le Main Gate Syndrom ou faut-il redéfinir notre conception du triage chirurgical?

INTRODUCTION: Recent suicide bombings pose the novel problem for Trauma Centers of the massive simultaneous arrival of many gravely wounded patients. METHODS: We report the experience of the French-German Military Trauma Group, a Level 2 Trauma Center, in Afghanistan during the wave of suicide bombings in February 2007. RESULTS: Fourteen casualties were received. A first triage was carried out by the U S Army Level I group prior to evacuation. A second surgical triage was carried out with systematic ultrasound exam. Four cases (ISS>25) were re-categorized and underwent emergency surgical procedures. CONCLUSION: Suicide bombing in crowded locations near an evacuation hospital may overwhelm the medical resources of the receiving center. It has been referred to as "The Main Gate Syndrome." We introduced the novel concept of a semi-evacuation hospital or receiving center where a second surgical triage was carried out. These exceptional circumstances require open-minded flexibility, a tailored approach, and close cooperation between surgeons and anesthetists to share experience, opinions, and ideas. In the setting of mass casualties, emergency ultrasound exam was shown to be a valuable and effective tool by virtue of its mobility, reproducibility, and immediate results.