Fabien Koskas

Management of Vascular Trauma during the Paris Terrorist Attack of November 13, 2015

BACKGROUNDnOn November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The Public Hospitals of Paris Organization and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study is to analyze the management of the victims presenting with a nonthoracic vascular trauma (NTVT).nnnMETHODSnAll the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively. A 6-month follow-up was obtained for all the patients.nnnRESULTSnAmong the 351 wounded, 20 (5.7%) patients had an NTVT and were dispatched in 8 hospitals (11 men of average age 32). NTVTs were gunshots in 17 cases (85%) or due to a handmade bomb in 3 cases (15%). Twelve patients (60%) received cardiopulmonary resuscitation during prehospital care. NTVT affected the limbs (14 cases, 70%) and the abdomen or the small pelvis (6 cases, 30%). All the patients were operated in emergency. Arterial lesions were treated with greater saphenous vein bypasses, by ligation, and/or embolization. Eleven venous lesions were treated by direct repair or ligation. Associated lesions requiring a specific treatment were present in 19 patients (95%) and were primarily osseous, nervous, and abdomino-pelvic. Severe postoperative complications were observed in 9 patients (45%). Fourteen patients (70%) required blood transfusion (6.4 U of packed red blood cells on average, range 0-48). There were no deaths or amputation and all vascular reconstructions were patent at 6 months.nnnCONCLUSIONSnThe effectiveness of the prehospital emergency services and a multisite and multidisciplinary management made it possible to obtain satisfactory results for NTVT casualties. All the departments of vascular surgery must be prepared to receive many wounded victims in the event of terrorist attacks.

Large-vessel vasculitis in human immunodeficiency virus-infected patients

Objective: The objective of this study was to describe large‐vessel vasculitis (LVV) in patients with human immunodeficiency virus (HIV) infection. It is a retrospective single‐center study conducted between 2000 and 2015 through a university hospital of 11 HIV‐infected patients with LVV. Methods: The characteristics and outcome of 11 HIV‐infected patients with LVV (7 patients fulfilled international criteria for Takayasu arteritis, 5 patients had histologic findings of vasculitis, and 5 patients had imaging features of aortitis) were analyzed and compared with those of 82 patients with LVV but without HIV infection. Results: Concerning the HIV‐infected patients with LVV (n = 11), the mean age was 40 years (range, 36‐56 years), and 55% of patients were female. At diagnosis of LLV, the mean initial CD4 cell count was 455 cells/mm3 (range, 166‐837 cells/mm3), and the median HIV viral load was 9241 copies. Vascular lesions were located in the aorta (n = 7), in supra‐aortic trunks (n = 7), and in digestive arteries (n = 3). Inflammatory aorta infiltrates showed a strong expression of interferon‐&ggr; and interleukin 6. In HIV‐negative LVV patients (n = 82), the median age was 42 years, and 88% of the patients were women. Thirty patients had an inflammatory syndrome. Seventy patients had been treated with glucocorticosteroids and 57 with immunosuppressive treatments. Compared with their negative counterparts, HIV‐positive patients with LVV were more frequently male (P = .014), had more vascular complications (ie, Ishikawa score; P = .017), and had more frequent revascularization (P = .047). After a mean follow‐up of 96 months, four relapses of vasculitis were reported, and one patient died. Regardless of the HIV virologic response, antiretroviral therapy improved LVV in only one case. Conclusions: LVV in HIV‐infected patients is a rare and severe entity.

Biosensor miniaturization for non-invasive measurements of materials and biological tissues

This paper presents about non-invasive planar complementary split ring resonators (CSRRs) coupled to microstrip line to measure the dielectric properties of materials and biological tissues. The expectations of health professionals are increasingly turning to less invasive surgical procedures and treatments. In particular, the monitoring of vital parameters (sweat, water in the lungs, etc.) or the evolution of certain pathologies, such as cancer cells, could be observed regularly if suitable devices were developed and could especially replace traditional invasive method. Appropriate miniaturized RF or microwave devices could be an alternative for some medical diagnostic applications. These devices would make it possible to determine the dielectric characteristics of biological tissues, which represent their real pathological states. Thus, it would be possible that dielectric contrast measurements will be able to follow the evolution of pathology, as well as the vital parameters of a patient. The objective of this research is to investigate a prototype biosensor that is suitable for measurements on biological tissues and can be miniaturized to enhance its spatial sensitivity. This work focuses on the design, electromagnetic simulations, and characterization of a new miniaturized biosensor at 2.4 GHz. The ex-vivo experimental results will be shown by measuring the S-parameters of various materials and animal biological tissues. The extraction of the dielectric parameters of these samples is obtained by the measurements of materials.