T Monchal

Publications (14)5.58 Total impact

• Article: [Hemorrhagic shock after cardiopulmonary resuscitation, bedside ultrasonography interest.]

  E d'Aranda, J Cotte, G Lacroix, T Monchal, E Meaudre
  Annales francaises d'anesthesie et de reanimation 12/2012; · 0.77 Impact Factor
• Article: Traumatic lower-limb ischemia: an unusual acute presentation of femoral bony exostosis

  Emmanuel Hornez, S. Ottomani, J. Bordes, T. Monchal, S. Bourgouin, Y. Baudoin, L. Meyrat, P. Leguilloux
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  ABSTRACT: The current observation reports a traumatic lower-limb ischemia due to an unusual mechanism, associating a bony exostosis and an open fracture of the femoral lower end. The exostosis was removed critically, allowing the artery to resume its modal anatomical location with no thrombosis or dissection. Femoral bony exostosis is rare. The usual presentation is subacute or chronic, leading to the emergence of pseudoaneurysms, and subsequently thrombosis.
  European Journal of Orthopaedic Surgery & Traumatology 04/2012; 19(5):357-359. · 0.10 Impact Factor
• Article: Management of exsanguinating pelvic trauma: Do we still need the radiologist?

  E Hornez, O Maurin, S Bourgouin, J Cotte, T Monchal, J de Roulhac, L Meyrat, J-P Platel, G Delort, E Meaudre, H Thouard
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  ABSTRACT: The hemodynamically unstable pelvic fracture are a diagnostic and therapeutic challenge. The current management is based on the control of pelvic bleeding by combining pelvic ring stabilization and embolization of pelvic arteries. The mortality of these patients, however, exceeds 30%. Recently the preperitoneal packing, based on the hemostatic tamponade of the pelvic cavity has been described. The objective of this study was to evaluate the interest of this new surgical procedure. The effectiveness of the standard algorithm is evaluated by analysis of pelvic injuries in 200 severe trauma treated at the Sainte-Anne Hospital. The results are then compared with literature data on the preperitoneal packing. The profile injury, management and morbidity and mortality was evaluated in 200 polytrauma. After an initial phase of resuscitation, unstable pelvic fractures were treated with a circumferential belt followed by the application of an external fixator. Arteriography was performed for all patients with persistent hemodynamic instability. The mean injury severity score (ISS) was 31 (4-75). The mean trauma-related injury severity score (TRISS) was 74% (3-99). The proportion of hemodynamically unstable patients was 47%. Fifteen patients (41%) had severe bleeding. The median number of blood transfusion was 10 (4-42); eight patients (22%) underwent embolization. For two patients, reducing the pelvic fracture with an external fixator resulted in permanent hemostasis. Two patients underwent a laparotomy first, for the control of a hemoperitoneum. The mortality rate of the group of patients with hemorrhage was 33% (5/15). This high mortality leads to reconsider the place of pelvic embolization as firstline treatment. Some major drawbacks are noted: its effectiveness in treating venous bleeding, availability and duration of the procedure. The preperitoneal packing is a fast and effective surgical alternative. It seems to improve hemodynamic status of patients and significantly reduce the use of embolization and massive transfusion. Embolization is still indicated for patients not responding to surgery. However survival is not significantly improved.
  Journal of Visceral Surgery 10/2011; 148(5):e379-84. · 0.57 Impact Factor
• Article: [Management of seat-belt aorta in severe polytrauma: a review].

  E Hornez, S Bourgouin, Y Baudoin, B Prunet, T Monchal, G Schlienger, L Meyrat, H Thouard
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  ABSTRACT: Blunt trauma of the abdominal aorta is rare. Secondary to high-energy trauma, it is observed mainly in association with complex lesions. Evaluation of injury to the aorta must be a priority due to the risk of life-threatening massive hemorrhage. The clinical presentation can be quite obvious but also variable and often misleading. If in doubt, a systematic injected whole body scan is essential to diagnose aortic lesions. Hemorrhage or ischemia dictates emergency laparotomy. Opening the retroperitoneum increases the risk of infection if there is an associated gastrointestinal tract injury and may contraindicate use of arterial prostheses. Endovascular treatment can be proposed for less symptomatic lesions, including intimal dissection. Stents can be inserted via a femoral approach. In the event of juxtarenal dissection, there is a risk of renal artery thrombosis. Endovascular treatment is currently not recommended. This treatment can be delayed for a few days if necessary. Morbidity is low and long-term results are good.
  Journal des Maladies Vasculaires 06/2011; 36(4):237-42. · 0.54 Impact Factor
• Article: [Desulfovibrio fairfieldensis bacteremia associated with acute sigmoiditis].

  T Gaillard, S Pons, C Darles, O Beausset, T Monchal, P Brisou
  Médecine et Maladies Infectieuses 01/2011; 41(5):267-8. · 0.72 Impact Factor
• Article: [Is emergency revascularization of tracheo-innominate artery fistulae mandatory?].

  S Bourgouin, E Hornez, T Monchal, Y Baudoin, L Meyrat, H Thouard
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  ABSTRACT: Tracheo-innominate artery fistulas are a rare but life-threatening complications (incidence between 0.1 and 1 %) occurring in tracheostomy patients. Surgery is the treatment of choice. Most authors recommend ligation of the innominate artery, which provides better results in terms of morbidity/mortality than revascularization surgery. We report here a case of innominate artery revascularization isolated from the trachea by a sternocleidomastoid pediculate interposition graft. The procedure was successful as demonstrated by the 2 years follow-up. Revascularization surgery should be reserved of specific cases. The risk of tracheal-mediated infections developing in contact with the vascular sutures warrants systematic use of an interposition graft isolating the trachea from the innominate artery.
  Journal des Maladies Vasculaires 12/2009; 35(1):38-42. · 0.54 Impact Factor
• Article: [Pyoderma gangrenosum mimicking abdominal sepsis after colorectal surgery].

  E Hornez, T Monchal, S Ottomani, S Bourgouin, J-P Platel, B Fournier, H Thouard
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  ABSTRACT: This study reports a case of pyoderma gangrenosum arising at a drainage orifice after a colostomy for cancer. The initial clinical presentation suggested intra-abdominal sepsis but the clinical assessment did not fit with laboratory findings or the CT scan. Forty hours later, the patient developed a reddish-purple ulcer at the drainage orifice. A diagnosis of pyoderma gangrenosum was made and systemic corticosteroid therapy was started. A dramatic response occurred over the next two days, obviating the need for surgical re-intervention. Pyoderma gangrenosum is an ulcerating necrotizing skin disorder of unknown etiology. It usually arises in association with underlying disease (mainly inflammatory bowel disease) and often occurs in para-stomal sites. Pyoderma gangrenosum arising at surgical sites is often mistaken for a postoperative infection and treated inappropriately with debridement and reopening of the wound which only exacerbates the pathology. Pyoderma gangrenosum is effectively treated with systemic corticosteroids.
  Journal de Chirurgie 11/2009; 146(6):576-8. · 0.50 Impact Factor
• Article: [Necrosis of the glans penis: a complication of an injection of buprenorphin in a opioid abuser].

  E Hornez, J Laroche, T Monchal, S Bourgouin, P Riviere, R Fournier, E Dantzer
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  ABSTRACT: Necrosis of the penis glans is commonly described after circumcision or strangulation. We report the case of a patient, opioid abuser, who presented an isolated glans necrosis after an injection of buprenorphin. The buprenorphin (Subutex) is a sublingual partial mu-opioid agonist used for the treatment of heroin dependance. Its intravenous or subcutaneous abuse is associated with local infection. The patient require a surgical intervention. After the failure of a mucosal graft, a soft skin graft was done.
  Annales de chirurgie plastique et esthetique 04/2009; 55(2):159-61. · 0.33 Impact Factor
• Article: [Double simultaneous fingertip metastasis of an epidermoid carcinoma. A case report].

  S Ottomani, M Levadoux, O Cathelineau, M Nguyen, T Monchal
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  ABSTRACT: Fingertip metastases are rare. The authors report the case of a patient with an epidermoid carcinoma of the larynx who presented with two separate finger pulp metastases in each hand. According to the literature this seems a very unusual occurrence. This diagnosis must be considered in the differential diagnosis of every suspicious fingertip lesion.
  Chirurgie de la Main 10/2008; 27(5):243-5. · 0.53 Impact Factor
• Article: [Ilio-ureteral fistula: a life-threatening complication of an iliac Candida-infected pseudoaneurysm. A case report].

  T Monchal, E Hornez, S Ottomani, J Laroche, S Bourgouin, L Meyrat, R Fournier, F Meusnier, H Thouard
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  ABSTRACT: Arterio-ureteral fistula is a rare condition difficult to diagnose. The usual presentation associates acute paroxysmal hematuria with well-identified history and risk factors. We report the case of an 84-year-old man with a life-threatening complication of an ilio-ureteral fistula complicating an anastomotic iliac pseudoaneurysm after prothetic iliofemoral surgery, due to a fungic infection by Candida. After reporting the clinical case and the emergency surgical treatment, we present a review of the literature.
  Journal des Maladies Vasculaires 06/2008; 33(2):101-5. · 0.54 Impact Factor
• Article: [White tumor of the wrist: a rare site of tuberculosis involvement].

  T Monchal, M Levadoux, N Pellet, M K Nguyen, S Ottomani, C Gaillard, E Hornez, C Michaut
  Médecine tropicale: revue du Corps de santé colonial 05/2007; 67(2):134.
• Article: Fistule ilio-urétérale : complication redoutable d’un faux anévrisme iliaque infecté à Candida. À propos d’un cas

  T. Monchal, E. Hornez, S. Ottomani, J. Laroche, S. Bourgouin, L. Meyrat, R. Fournier, F. Meusnier, H. Thouard
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  ABSTRACT: Arterio-ureteral fistula is a rare condition difficult to diagnose. The usual presentation associates acute paroxysmal hematuria with well-identified history and risk factors. We report the case of an 84-year-old man with a life-threatening complication of an ilio-ureteral fistula complicating an anastomotic iliac pseudoaneurysm after prothetic iliofemoral surgery, due to a fungic infection by Candida. After reporting the clinical case and the emergency surgical treatment, we present a review of the literature.
  Journal des Maladies Vasculaires.
• Article: Ruptured liver cell adenoma in man: great fortune in misfortune.

  T Monchal, L Barbier, E Hornez, S Marciano, J Ph Dales, S Berdah, V Moutardier
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  ABSTRACT: Liver cell adenoma is mostly known as a tumour affecting women with long-term use of contraceptive hormones. Its incidence in men is very low, and particularly few cases of acute complications are related in the literature. We report the case of a 44-year-old man presenting with a life-threatening rupture of a hepatic tumour, successfully treated in emergency with primary endovascular embolization, followed by hepatectomy, once stabilized. The pathological findings were fortunately consistent with the diagnosis of liver-cell adenoma. To our knowledge, it is the first case reported in a man treated by a combined interventional radiological and surgical approach.
  Acta chirurgica Belgica 110(5):555-7. · 0.43 Impact Factor
• Article: Pyoderma gangrenosum sur un orifice de drainage, pris pour un sepsis abdominal après une chirurgie colorectale

  E. Hornez, T. Monchal, S. Ottomani, S. Bourgouin, J.-P. Platel, B. Fournier, H. Thouard
  [show abstract] [hide abstract]
  ABSTRACT: This study reports a case of pyoderma gangrenosum arising at a drainage orifice after a colostomy for cancer. The initial clinical presentation suggested intra-abdominal sepsis but the clinical assessment did not fit with laboratory findings or the CT scan. Forty hours later, the patient developed a reddish-purple ulcer at the drainage orifice. A diagnosis of pyoderma gangrenosum was made and systemic corticosteroid therapy was started. A dramatic response occurred over the next two days, obviating the need for surgical re-intervention. Pyoderma gangrenosum is an ulcerating necrotizing skin disorder of unknown etiology. It usually arises in association with underlying disease (mainly inflammatory bowel disease) and often occurs in para-stomal sites. Pyoderma gangrenosum arising at surgical sites is often mistaken for a postoperative infection and treated inappropriately with debridement and reopening of the wound which only exacerbates the pathology. Pyoderma gangrenosum is effectively treated with systemic corticosteroids.
  Journal de Chirurgie. 146(6):576-578.