L'aménagement villageois sylvo-pastoral de la formation de brousse tachetée de Tientiergou (arrondissement de Say, Niger)

Le schéma directeur d'approvisionnement en bois de la ville de Niamey (SIDAN) a été établi en 1991. Il a servi de base aux textes réglementaires et fiscaux et au démarrage des actions de développement des premiers marchés ruraux et des aménagements forestiers. Le premier site choisi pour tester les aménagements forestiers a été celui de Tientiergou, dans l'arrondissement de Say à 50 km au Sud de Niamey. L'objectif visé était de mettre au point les techniques d'exploitation des formations arbustives à Combrétacées, caractéristiques des plateaux de la périphérie de la ville de Niamey. Ces modes d'exploitation devaient à la fois garantir une bonne préservation du milieu et donner aux populations rurales les moyens de les préserver, soit par des plantations ou des actions de DRS/CES, soit par une meilleure gestion agricole de leurs terres. Après avoir fait l'historique des aménagements forestiers au Niger, cet article présente le contexte physique et social du massif forestier de Tientiergou (30 000 ha), la situation agricole et pastorale, enfin l'inventaire des ressources ligneuses réalisé préalablement à l'aménagement. Les zones aménagement de type orienté (sans aménagements forestiers) ont un coût faible, qui varie de 1 270 FCFA/ha (pour un terroir de 3 500 ha) à 4 430 FCFA/ha (pour un terroir de 1 000 ha). Les aménagements forestiers (marchés ruraux contrôlés) entraînent une augmentation de plus de deux fois ce coût ( de 3 840 à 8 440 FCFA/ha). (Résumé d'auteur

Management of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a retrospective multi-center cohort study

Background and study aims  Delayed bleeding (DB) is the most frequent major adverse event after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs). Evidence-based guidelines for management of DB are lacking. We aimed to evaluate the clinical presentation, treatment and outcome of patients with DB and to determine factors associated with hemostatic therapy. Patients and methods  Patients with DB were identified by analyzing all consecutive EMR procedures for LNPCPs (≥ 2 cm) from one academic center (2012-2017) and seven regional hospitals (2015-2017). DB was defined as any postprocedural bleeding necessitating emergency department presentation, hospitalization or reintervention. Outcome of DB was assessed for three clinical scenarios: continued bleeding (CB), spontaneous resolution without recurrent bleeding during 24 hours observation (SR), and recurrent bleeding (RB). Variables associated with hemostatic therapy were analyzed using logistic regression. Results  DB occurred after 42/542 (7.7 %) EMR procedures and re-colonoscopy was performed in 30 patients (72 %). Re-colonoscopy and hemostatic therapy rates were 92 % and 75 % for CB (n = 24), 25 % and 8 % for SR (n = 12), and 83 % and 67 % for RB (n = 6), respectively. Frequent hematochezia (≥ hourly) was the only factor significantly associated with hemostatic therapy (RR 2.23, p = 0.01). Re-bleeding after endoscopic hemostatic therapy occurred in 3/22 (13.6 %) patients. Conclusion  Ongoing or recurrent hematochezia is associated with a high rate of hemostatic therapy, warranting re-colonoscopy in these patients. A conservative approach is justified when bleeding spontaneously settles, and without recurrent hematochezia during 24 hours observation patients can be safely discharged without endoscopic re-examination

Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions A Prospective Multicenter Cohort Study (LIMERIC-Study)

Objective: The aim of this study was to evaluate the safety and efficacy of a modified CAL-WR. Summary Background Data: The use of segmental colectomy in patients with endoscopically unresectable colonic lesions results in significant morbidity and mortality. CAL-WR is an alternative procedure that may reduce morbidity. Methods: This prospective multicenter study was performed in 13 Dutch hospitals between January 2017 and December 2019. Inclusion criteria were (1) colonic lesions inaccessible using current endoscopic resection techniques (judged by an expert panel), (2) non-lifting residual/recurrent adenomatous tissue after previous polypectomy or (3) an undetermined resection margin after endoscopic removal of a low-risk pathological T1 (pT1) colon carcinoma. Thirty-day morbidity, technical success rate and radicality were evaluated. Results: Of the 118 patients included (56% male, mean age 66 years, standard deviation +/- 8 years), 66 (56%) had complex lesions unsuitable for endoscopic removal, 34 (29%) had non-lifting residual/recurrent adenoma after previous polypectomy and 18 (15%) had uncertain resection margins after polypectomy of a pT1 colon carcinoma. CAL-WR was technically successful in 93% and R-0 resection was achieved in 91% of patients. Minor complications (Clavien-Dindo i-ii) were noted in 7 patients (6%) and an additional oncologic segmental resection was performed in 12 cases (11%). Residual tissue at the scar was observed in 5% of patients during endoscopic follow-up. Conclusions: CAL-WR is an effective, organ-preserving approach that results in minor complications and circumvents the need for major surgery. CAL-WR, therefore, deserves consideration when endoscopic excision of circumscribed lesions is impossible or incomplete.Cellular mechanisms in basic and clinical gastroenterology and hepatolog