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Biomedical subjects

D P Rignault

Publications and source records attributed to D P Rignault.

8 recordsLinked to original sources
PubMed1999

Civilian versus military trauma dogma: who do you trust?

Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. A review of historical as well as current vivilian and military data is presented for four trauma topics (military antishock trousers, wound debridement, colon wounds, fluid resuscitation) in which civilian and military principles have clashed. The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.

Adult↗
PubMed1990

Is war surgery a specialty? Part I.

Since 1950 the peacetime practice of civilian and military surgery has shifted from general surgery to increasing specialization and subspecialization. The surgical management of war wounds continues to require a solid foundation in general surgery training and experience, plus additional specific training in wartime surgery. Even the trauma specialist will face significant differences and difficulties treating war wounds in field hospitals. Neither military nor civilian surgical programs provide this training. This two-part essay identified major characteristics of War Surgery and explores the essential training and education required to prepare civilian and military surgeons for the practice of war surgery.

Emergencies↗
PubMed1990

How to train war surgery specialists: Part II.

Since 1950 the peacetime practice of civilian and military surgery has been characterized by increasing specialization and subspecialization. The surgical management of war wounds continues to require a solid foundation in general surgery training and experience, plus additional specific training in war surgery. Even the trauma specialist will face significant differences and difficulties treating war wounds in field hospitals. Neither military nor civilian surgical programs provide this training. This two-part essay identifies major characteristics of war surgery and explores the essential training and education required to prepare civilian and military surgeons for the practice of war surgery.

General Surgery↗
PubMed1989

The 1986 terrorist bombing experience in Paris.

Between December 7, 1985 and September 17, 1986, eleven terrorist bomb explosions took place in Paris. Thirteen people died immediately, 255 others were injured. Forty were treated on-site and were not hospitalized, 205 were subjected to triage and stabilization and were then hospitalized. These latter 205 patients are analyzed in this study. None of them died during transportation, and seven eventually died in hospitals. Forty-seven per cent of all victims suffered from multiple injuries. All deaths except one occurred in the polytraumatized group. The policy of subjecting victims of terrorist bomb explosions to triage and stabilization before hospitalization is compared to the so-called "scoop and run" technique, more generally applied in mass casualty situations. Its limitations and advantages are discussed.

Adult↗
PubMed1986

Properitoneal prosthetic inguinal hernioplasty through a Pfannenstiel approach.

The recurrence rate after conventional inguinal hernia repair remains a matter of discussion and controversy. Reoperation for a postoperative recurrent hernia, especially when the defect is large, may be difficult if more than one operation has been performed. The idea of interposing a large surface of prosthetic mesh between the peritoneum and the deficient inguinal wall instead of "mending" the defect, represents a radical departure from previous methods of hernia repair. The mesh interposed between the properitoneal space and the musculofascial structures is the only obstacle to peritoneal and visceral protrusion. The mesh must be much larger than the defect, since it is not sutured in place and only intra-abdominal pressure maintains it in place over the hernia defect. This operation constitutes a prosthetic hernioplasty in contrast to the classic reparative herniorrhaphy. It can be carried out through an inguinal, midline or Pfannenstiel incision. During a period of 14 years, 767 patients underwent hernioplasty while 1,382 underwent conventional herniorrhaphy. The number and severity of septic complications was comparable in two groups--2 per cent. The reliability and efficiency of the technique described is demonstrated by the low recurrence rate after reoperation for recurrent hernia: only three (1.2 per cent) recurrences after 239 hernioplasty operations. Of the three techniques for hernioplasty, the "Pfannenstiel" appears to be the easiest, safest and most comfortable for the patient.

Hernia, Inguinal↗
PubMedDate not supplied

Abdominal trauma in war.

In war, the percentage of casualties with abdominal wounds on battlefields is near 20%. Roughly half of these casualties die almost immediately from bleeding. Wounding agents are most often either bullets or fragments from various detonating devices. Severity of pathology induced by these agents and prolonged lag time between injury and treatment constitute major differences between peace and war abdominal injuries. Since the means of diagnosis is unsophisticated in war, penetrating abdominal injury leads to systematic exploratory laparotomy, although 10% to 20% of explorations are negative. The management of colon lesions remains a controversial issue. In modern war surgery manuals, primary colon repair is not totally condemned and is generally considered acceptable, but under stricter criteria than in civilian practice. In abdominal war wounds, mortality rate dropped from 53% during World War I to 18-36% at the end of World War II. In Vietnam it went down near 10% in some limited hospital series. But other data collected during that conflict show a less rosy picture. Of 476 abdominal casualties, the total mortality reached 42%. The hospital mortality among the survivors was 11.5%. Death in cases where abdominal wound was the primary lesion was due to hemorrhage in 60%, sepsis in 25%, and pulmonary insufficiency in 15%. Survivors had an average of 1.8 injured organs.

Abdominal Injuries↗
PubMedDate not supplied

The "functional" popliteal entrapment syndrome.

A patient with bilateral entrapment syndrome is reported, he only had symptoms of intermittent claudication with running. The "neutral angiograms" were normal, but the "dynamic angiographies" taken in the sustained active plantar flexion showed a complete occlusion of both popliteal arteries. No abnormalities, no anatomical trap were discovered at the time of surgery. The entrapment syndrome was caused by the muscular hyperdevelopment in this intensively trained athlete. That leads to the concept of "functional entrapment" versus "organic, anatomical entrapment". The diagnostic value of the invasive and non invasive techniques is discussed. Surgical exploration is diagnostic: this is the only means to rule out any organic anatomical entrapment. In a "functional entrapment" surgery may or may not be therapeutic.

Adult↗