M Carles

Princess Grace Hospital Centre, Monaco-Ville, Monaco

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Publications (93)151.73 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation > 85° in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018). Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2014; · 2.79 Impact Factor
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    ABSTRACT: The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery. The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We searched the files in the SHAM database, and then analyzed them. On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n=16) and nosocomial infections (n=13). The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery.
    Annales francaises d'anesthesie et de reanimation 02/2014; · 0.77 Impact Factor
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    ABSTRACT: Introduction This study reports a series of patients operated on by anterior cruciate ligament (ACL) reconstruction combined with valgus high tibial osteotomy (HTO) for chronic anterior knee instability associated with medial tibiofemoral osteoarthritis. It was hypothesized that the combined surgery would enable return to sport, stabilize the knee and relieve medial pain. Patients and methods A retrospective study enrolled a continuous series of 29 patients (20 males, nine females; mean age, 43 years (range, 25–56 yrs), at a mean 14 years (range, 2–29 yrs) after the initial injury. ACL autograft used a bone-patellar tendon-bone transplant in 12 patients and hamstring tendon transplant in 17. Medial opening wedge HTO used an asymmetric wedge plate. Results were assessed on subjective and objective IKDC scores, monopodal weight-bearing and full-leg radiographs, telemetry and Merchant view at a mean 6 years follow-up (range, 25 months to 12 years). Results At follow-up, 23 patients had resumed sports activities, with 45% in competitive sports; 28 were free of instability and 21 free of pain. Mean subjective IKDC score was 77 (34–97) and 70% had A or B global objective IKDC scores. The knee axis was in 2.5° valgus. Discussion Combined ACL graft and valgus HTO relieved pain in 70% of cases, and restored knee stability enabling return to sport in 80%. Level of evidence Level IV. Retrospective therapeutic study.
    Orthopaedics & Traumatology Surgery & Research 01/2014; · 1.06 Impact Factor
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    ABSTRACT: The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery. Objective The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. Study design We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. Materials and methods We searched the files in the SHAM database, and then analyzed them. Results On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n = 16) and nosocomial infections (n = 13). Conclusions The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery.
    Annales francaises d'anesthesie et de reanimation 01/2014; · 0.77 Impact Factor
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    ABSTRACT: Introduction Cette étude porte sur une série de patients opérés d’une laxité antérieure chronique associée à une pré-arthrose ou à une arthrose fémoro-tibiale médiale par autogreffe du ligament croisé antérieur (LCA) associée à une ostéotomie tibiale de valgisation (OTV). L’hypothèse était que cette intervention combinée permet la reprise du sport, de stabiliser le genou et de soulager les douleurs médiales. Patients et méthodes L’étude rétrospective portait sur une série continue de 29 patients, 20 hommes et 9 femmes, d’âge moyen 43 ans (25 à 56), 14 ans (2–29) après l’entorse initiale. L’autogreffe du LCA était réalisée avec un transplant os–tendon patellaire–os chez 12 patients et un transplant aux tendons ischio-jambiers chez 17. L’ostéotomie de valgisation par ouverture médiale était réalisée grâce à une plaque à cale asymétrique. Les résultats ont été évalués par les scores IKDC subjectif et objectif, par des radiographies en appui monopodal et schuss, télémétrie, défilé fémoro-patellaire à un recul moyen de 6 ans (25 mois à 12 ans). Résultats Au recul, 23 patients avaient repris une activité sportive, dont 45 % en compétition, 28 ne ressentaient plus d’instabilité et 21 n’avaient plus de douleur. Le score IKDC subjectif était de 77 points (34 à 97) et 70 % des patients avaient un score IKDC objectif global A ou B. L’axe du genou était en valgus de 2,5°. Discussion La greffe du LCA combinée à une OTV permet de soulager les douleurs dans 7 cas sur 10, de restaurer la stabilité du genou et de reprendre le sport dans 8 cas sur 10. Niveau de preuve Niveau IV. Étude rétrospective thérapeutique.
    Revue de Chirurgie Orthopédique et Traumatologique 01/2014; 100(2):166–170.
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    ABSTRACT: Chronic bone infection is associated with bone resorption. From animal studies, CD3/CD28 activated T-cells are known to enhance osteoclastogenesis and bone resorption. Since CD28 is constitutively expressed on T-cells and its expression is downregulated by chronic exposure to inflammatory environment, we characterized costimulatory molecule expression on T-cells from chronically infected patients. We used cytofluorometric techniques to phenotypically characterize T-cells, its costimulatory molecules and perforin secretion from infected and non-infected human bones. Chronic bone infection was defined as infection lasting for more than a month. We show a higher T-cell activation (HLA-DR+) in infected bones compared to non-infected: median being 16% versus 7%, p=0.009 for CD4 T-cells, and 33% versus 15%, p=0.038 for CD8 T-cells respectively. However, T-cell proliferation (Ki67+) was lower for CD8 T-cells in infected bones: 26% versus 34%, p=0.045. In contrast, we detected no difference in apoptosis and regulatory T-cells. In infected bone, we found higher CD28 negative CD4+ T-cells compared to non-infected ones: 20% versus 8% respectively (p=0.005); this T-cell subset had higher CD11b expression and perforin secretion. Chronically infected human bones are characterized by an increase of CD28 negative CD4+ T-cells, indicating long-term activated cells with cytotoxic ability. Therefore this alteration of costimulatory molecules may modify interactions with osteoclasts and impact bone resorption.
    Clinical & Experimental Immunology 12/2013; · 3.41 Impact Factor
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    ABSTRACT: The purposes of this study were (1) to identify the risk factors for tuberosity complications and poor functional outcomes and (2) to compare a standard humeral stem with a fracture-specific humeral stem in hemiarthroplasty for the treatment of 3- and 4-part proximal humeral fractures. We retrospectively reviewed the cases of 60 consecutively operated patients (61 shoulders) using radiographs and computed tomography scans. There were 56 displaced four-part and 5 three-part fractures. The technique was standardized for prosthesis positioning in height and retroversion and for tuberosity fixation. A conventional standard stem was implanted in the first 31 shoulders (group A), and a specific fracture stem was implanted in the next 30 shoulders (group B). The sample size needed for comparison was predetermined with an a priori power analysis. The mean follow-up period was 64 months (range, 24 to 150 months). At the last follow-up, the greater tuberosity was healed in an adequate (anatomic) position in 45% of the patients in group A (14 of 31) and 87% of those in group B (26 of 30) (P = .0001). Active forward elevation, active external rotation, and the Constant score were significantly better with fracture stems (136°, 34°, and 68 points, respectively) than with conventional stems (113°, 23°, and 58 points, respectively) (P < .0001). Regardless of the type of implant used, patients aged 75 years or older and women had significantly lower functional results and higher rates of tuberosity complications (P < .0001). Good functional outcomes can be anticipated after hemiarthroplasty for proximal humeral fractures if the greater tuberosity is anatomically positioned (ie, lateral to the stem) and healed around the prosthesis. The use of a specific fracture stem allows to double the rate of tuberosity healing compared to a conventional stem (87% vs. 45%), decreases complications and improves shoulder function. Risk factors associated with poor functional results and anatomic failures are (1) patient age (≥75 years), (2) patient gender (women), and (3) use of a conventional (bulky) stem.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2013; · 1.93 Impact Factor
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    ABSTRACT: Introduction et hypothèse L’hypothèse de cette étude est que le taux de récidive d’instabilité antérieure de l’épaule du Bankart arthroscopique avec ancres est supérieur à celui de la butée coracoïdienne de Latarjet. Patients et méthodes Étude rétrospective monocentrique continue concernant une cohorte de patients tous opérés pour instabilité antéro-inférieure post-traumatique récidivante sur la même période (2004–2005) : 51 patients opérés par butée de Latarjet à ciel ouvert ont été appariés par l’âge au moment de la chirurgie à 51 patients opérés par Bankart arthroscopique. Tous les patients ont été évalués par un questionnaire et 50 % ont pu être revus en consultation avec des radiographies. Une récidive d’instabilité était définie par au moins un épisode de luxation ou de subluxation antérieure. Résultats Les deux groupes étaient statistiquement comparables pour les données démographiques et les lésions capsulo-ligamentaires et osseuses. Au recul moyen de cinq ans, le taux de récidive était de 24 % dans le groupe Bankart et de 12 % dans le groupe butée (p = 0,12). Dans le groupe Bankart, l’âge inférieur à 25 ans (p = 0,01), le sport de compétition après la chirurgie (p = 0,01) et un éculement glénoïdien (p = 0,02) constituaient des facteurs de risque indépendants de récidive. Dans le groupe butée, sur six récidives, cinq erreurs techniques ont été identifiées. Quinze des 18 récidives n’ont pas été réopérées car restaient satisfaits de l’opération. Discussion et conclusions À cinq ans de recul, le taux de récidive d’instabilité du Bankart arthroscopique est deux fois celui de la butée coracoïdienne. Les patients jeunes, souhaitant pratiquer un sport de compétition et présentant un éculement glénoïdien ne sont pas de bons candidats pour le Bankart arthroscopique. Celui-ci présente un taux de récidive rédhibitoire en l’absence de sélection des patients. La butée de Latarjet à ciel ouvert présente un taux de récidive non négligeable lié à des erreurs techniques. Niveau de preuve IV (étude rétrospective).
    Revue de Chirurgie Orthopédique et Traumatologique 04/2013; 99(2):95–102.
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    ABSTRACT: INTRODUCTION AND HYPOTHESIS: The hypothesis of this study was that the rate of recurrence of anterior instability of the shoulder after arthroscopic Bankart repair with suture anchors is higher than after coracoid bone block (Latarjet procedure). MATERIALS AND METHODS: This continuous retrospective monocentric study included a cohort of patients who underwent surgery for post-traumatic recurrent antero-inferior instability (2004-2005): 51 patients who underwent an open Latarjet procedure were paired for age at surgery to 51 patients who underwent an arthroscopic Bankart repair. All patients were evaluated with a questionnaire and 50% were evaluated in a follow-up consultation with X-rays. Recurrent instability was defined by at least one episode of anterior dislocation or subluxation. RESULTS: Demographic data, soft tissue and bone lesions were statistically similar between the groups. At 5years follow-up, the recurrence rate was 24% in the Bankart group and 12% in the Latarjet group (P=012). In the Bankart group, age under 25years old (P=0.01), competitive sports after surgery (P=0.01), and glenoid erosion (P=0.02) were independent risk factors of recurrence. In the Latarjet group, five technical errors were identified out of six cases of recurrence. Fifteen of the 18 cases of recurrence did not undergo revision surgery because patients remained satisfied with their results. DISCUSSION AND CONCLUSIONS: At 5years of follow-up, the rate of recurrent instability following arthroscopic Bankart repair was two times higher than that following the coracoid bone block procedure. Young patients who wish to practice a competitive sport or present with glenoid erosion are poor candidates for arthroscopic Bankart repair. The rate of recurrence is extremely high in unselected patients. The open Latarjet procedure results in a fairly high rate of recurrence due to technical errors. LEVEL OF EVIDENCE: Level IV (retrospective study).
    Orthopaedics & Traumatology Surgery & Research 03/2013; · 1.06 Impact Factor
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    ABSTRACT: It is in this atmosphere fuelled by the recent scandal of the PIP implants that the final court of appeal has given a judgment on July 12, 2012 which reorients the debate. While patients seeked a shared responsibility between the provider of the implants and the surgeon, in this case of faulty testicular implants, the final court of appeal just ruled out the responsibility of the surgeon. But this jurisprudence can only be applied to private law, i.e. for private healthcare whereas lawsuits filed against public hospitals depend on a different legal liability system.
    Annales de chirurgie plastique et esthetique 02/2013; · 0.33 Impact Factor
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    ABSTRACT: It is in this atmosphere fuelled by the recent scandal of the PIP implants that the final court of appeal has given a judgment on July 12, 2012 which reorients the debate. While patients seeked a shared responsibility between the provider of the implants and the surgeon, in this case of faulty testicular implants, the final court of appeal just ruled out the responsibility of the surgeon. But this jurisprudence can only be applied to private law, i.e. for private healthcare whereas lawsuits filed against public hospitals depend on a different legal liability system.
    Annales de Chirurgie Plastique Esthétique. 01/2013; 58(4):267–270.
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    ABSTRACT: Introduction Le remplacement prothétique bilatéral de genou en une session opératoire offre les avantages d’un seul séjour hospitalier, d’une rééducation raccourcie et d’une diminution du coût de prise en charge par patient. Cependant, la crainte d’un taux plus élevé de complications périopératoires a jusqu’alors freiné cette stratégie. L’hypothèse de cette étude est que, chez des patients sélectionnés, cette stratégie n’engendre pas de complications graves. Patients et méthodes Cette étude pilote prospective, de type série continue sans groupe témoin a porté sur une période de 24 mois. Les critères d’inclusion étaient une gonarthropathie bilatérale non infectieuse, chez des patients classés ASA 1 ou 2 (American Society of Anesthesiology) et présentant une hémoglobine préopératoire d’au moins 13 g/dL. Tous les patients ont été évalués en pré- et postopératoire à l’aide des scores International Knee Society Score (IKS) et Knee Injury And Osteoarthritis Score (KOOS). Résultats Trente patients ont été inclus dans l’étude (25 femmes), âge moyen 70,3 ans (32 à 88 ans) ; cinq ASA 1 et 25 ASA 2. Tous les patients ont été suivis et évalués sur une durée moyenne de 18 mois (six à 30 mois). Trois thromboses veineuses profondes, un accident cardiopulmonaire et trois confusions ont été recensés mais aucun décès périopératoire, embolie pulmonaire, infection nosocomiale ou reprise chirurgicale. À 18 mois, l’IKS est passé de 98 (33 à 139) en préopératoire à 169 (62 à 200) en postopératoire. Les cinq composantes du KOOS ont été significativement améliorées. Discussion Cette série préliminaire confirme que le remplacement prothétique bilatéral de genou en une session opératoire est une alternative fiable au remplacement en deux sessions chez les patients ASA 1 et 2. Compte tenu de l’économie de santé que cette stratégie représente, il serait pertinent que les pouvoirs publics la favorisent en créant un groupe homogène de patients dédié. Niveau de preuve 4, prospectif sans groupe témoin.
    Revue de Chirurgie Orthopédique et Traumatologique 12/2012; 98(8):771–776.
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    ABSTRACT: INTRODUCTION: Bilateral total knee arthroplasty (TKA) in a one-stage surgical procedure has the advantage of a single hospital stay, shorter rehabilitation, and reduced patient management costs. However, until now the use of this strategy has been limited by the fear of a higher rate of perioperative complications. The hypothesis of this study was that in selected patients, this management strategy would not result in any serious complications. MATERIALS AND METHODS: This prospective 24-month pilot study was performed in a continuous series of patients without a control group. Inclusion criteria were bilateral non-infectious gonarthropathy, in patients classified as American Society of Anesthesiology (ASA) 1 or 2 and presenting with a preoperative hemoglobin level of at least 13g/dL. All patients underwent a pre- and postoperative evaluation using the International Knee Society (IKS) and Knee Injury and Osteoarthritis Score (KOOS) scores. RESULTS: Thirty patients were included in the study (25 women, mean age 70.3years old [32 to 88years]; five ASA 1 and 25 ASA 2). All patients were followed-up and evaluated for a mean 18months (6 to 30months). Three deep vein thromboses, one cardiopulmonary accident and three confusional states were reported, but there were no perioperative deaths, pulmonary embolisms, nosocomial infections or revision procedures. At 18months follow-up the IKS score had improved from 98 (33-139) preoperatively to 169 (62-200) postoperatively. The five items of the KOOS score improved significantly. DISCUSSION: This preliminary series confirms that bilateral total knee replacement in a one-stage surgical procedure is a reliable alternative to a two-stage procedure in ASA 1 and 2 patients. Because of the savings in health costs with this strategy, public healthcare authorities should provide support by creating and sponsoring a specific group for further study. LEVEL OF EVIDENCE: 4, prospective, no control group.
    Orthopaedics & Traumatology Surgery & Research 11/2012; · 1.06 Impact Factor
  • Annales francaises d'anesthesie et de reanimation 09/2012; 31(9):e179–e183. · 0.77 Impact Factor
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    ABSTRACT: BACKGROUND: Advantages of one-stage bilateral total hip arthroplasty (THA) include a single hospital stay, a shorter rehabilitation time, and decreased management costs per patient. However, concern about a possible increase in the perioperative complication rate has limited the use of this strategy. Here, our objectives were to evaluate morbidity and mortality, as well as functional outcomes, in patients managed with one-stage bilateral THA. HYPOTHESIS: The complication rate after one-stage bilateral THA is not significantly different from that after unilateral THA. MATERIALS AND METHODS: Four French surgical centres participated in a retrospective observational study of patients managed with one-stage bilateral THA. The 112 included patients (55 women) had a mean age of 59years (range, 22-84) and a mean follow-up of 30months (6-103). RESULTS: Mean hospital stay length was 10.8days (6-27), mean operative time was 162minutes (95-270), and mean haemoglobin levels were 14.3g/dL preoperatively and 10.1g/dL postoperatively. No perioperative deaths were recorded. Deep vein thrombosis occurred in eight (7.1%) patients and pulmonary embolism in six (5.4%). The Merle d'Aubigné score improved from 9.25±2.9 (3-16) preoperatively to 17.5±1 (14-18) at last follow-up. All but three patients (109/112, 97%) said they would choose the same operation again and 102/112 (91%) said they would recommend it to a family member. DISCUSSION: The results of this multicentre retrospective study indicate that one-stage bilateral THA is a valid alternative to two-stage bilateral THA in ASA 1 and 2 patients with a preoperative haemoglobin level of about 14g/L. The major complication rate was 7.1%, which was slightly higher than after unilateral THA, and the main complications were deep vein thrombosis and pulmonary embolism. LEVEL OF EVIDENCE: Level IV (multicentre retrospective observational study).
    Orthopaedics & Traumatology Surgery & Research 08/2012; · 1.06 Impact Factor
  • Annales francaises d'anesthesie et de reanimation 07/2012; 31(9):e179-83. · 0.77 Impact Factor
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    ABSTRACT: The tubal sterilization is a safe and recognized sterilization method. The complications of this intervention are rare and mainly concern failure of surgical procedure or clip migrations. We report the first case of spontaneous migration of a clip behind the psoas followed by a chronic osteitis.
    Gynécologie Obstétrique & Fertilité 02/2012; 40(6):379-81. · 0.55 Impact Factor
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    ABSTRACT: Surgical training relies on medical school lectures, practical training in patient care and in the operating room including instruction in anatomy and experimental surgery. Training with different techniques of simulators can complete this. Simulator-based training, widely used in North America, can be applied to several aspects of surgical training without any risk for patients: technical skills in both open and laparoscopic surgery, the notion of teamwork and the multidisciplinary management of acute medicosurgical situations. We present the curriculum developed in the Simulation Center of the Medical School of Nice Sophia-Antipolis. All residents in training at the Medical School participate in this curriculum. Each medical student is required to pursue theoretical training (familiarization with the operating room check-list), training in patient management using a high fidelity mannequin for various medical and surgical scenarios and training in technical gestures in open and laparoscopic surgery over a 2-year period, followed by an examination to validate all technical aptitudes. This curriculum has been approved and accredited by the prestigious American College of Surgeons, making this the first of its kind in France. As such, it should be considered as a model and, in accordance to the wishes of the French Surgical Academy, the first step toward the creation of true schools of surgery.
    Journal of Visceral Surgery 02/2012; 149(1):e52-60. · 1.17 Impact Factor
  • Source
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    ABSTRACT: Introduction Surgical training relies on medical school lectures, practical training in patient care and in the operating room including instruction in anatomy and experimental surgery. Training with different techniques of simulators can complete this. Simulator-based training, widely used in North America, can be applied to several aspects of surgical training without any risk for patients: technical skills in both open and laparoscopic surgery, the notion of teamwork, and the multidisciplinary management of acute medico surgical situations. Method We present the curriculum developed in the Simulation Center of the Medical School of Nice Sophia-Antipolis. All residents in training at the medical school participate in this curriculum. Results Each medical student is required to pursue theoretical training (familiarization with the operating room check-list), training in patient management using a high fidelity mannequin for various medical and surgical scenarios, and training in technical gestures in open and laparoscopic surgery over a 2-year period, followed by an examination to validate all technical aptitudes. This curriculum has been approved and accredited by the prestigious American College of Surgeons, making this the first of its kind in France. Conclusion As such, it should be considered as a model and, in accordance to the wishes of the French Surgical Academy, the first step toward the creation of true schools of surgery.
    Journal de Chirurgie Viscérale. 02/2012; 149(1):55–63.
  • Michel Carles, Marc Raucoules-Aimé
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    ABSTRACT: Diabetic patients can be managed in day-case surgery when blood glucose is properly controlled and when patients are compliant to the constraints of ambulatory practice. Insulin or sulphonylurea are given on the morning of surgery, in agreement with the usual schedule. Breakfast is briefly replaced by an intravenous carbohydrate intake, until next oral feeding. For type 2 diabetic patients, a “no glucose–no insulin” protocol may be used. Biguanides have to be stopped 24 hours before surgery. Scheduling surgery early in the morning permits to take a snack at lunchtime and allows the patient to be discharged home in the afternoon, after a last blood glucose control. Vomiting and hyperglycaemia are contraindication to discharge.
    New Scientist - NEW SCI. 12/2011;

Publication Stats

604 Citations
38 Downloads
151.73 Total Impact Points

Institutions

  • 2005–2013
    • Princess Grace Hospital Centre
      Monaco-Ville, Monaco
  • 2012
    • Université Paris Descartes
      Lutetia Parisorum, Île-de-France, France
  • 1998–2011
    • Centre Hospitalier Universitaire de Nice
      Nice, Provence-Alpes-Côte d'Azur, France
  • 1995–2011
    • University of Nice-Sophia Antipolis
      Nice, Provence-Alpes-Côte d'Azur, France
  • 2008
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2006
    • Ecole Universitaire de Management
      Nice, Provence-Alpes-Côte d'Azur, France