Les dictionnaires d'Alexakis

Article consacré à ce "complice" central dans l'oeuvre d'Alexakis, pour qui on peut dire que le français est, contrairement à l'adage, la langue du Robert. A l'entrée « dictionnaire » du Grand Robert, on trouve une citation d'Alexakis. On ne s'en étonne guère tant la pratique du dictionnaire occupe une place centrale dans la deuxième partie de son oeuvre. Certains écrivains ont pu déplorer l'entrave à l'expressivité que constitue l'usage littéraire d'une langue étrangère et dire comme Cioran que « changer de langue, c'est écrire une lettre d'amour avec un dictionnaire ». Or Alexakis n'y verrait rien de mal qui met régulièrement en scène l'attachement complice d'un écrivain à un lexique, une encyclopédie ou un Trésor. Explorant les intervalles qui se créent entre le sujet multilingue et ses langues d'expression, plusieurs de ses textes vérifient ces deux propositions : que la langue n'est pas une ; et que l'on peut aussi être séparé de sa langue première. Par une lecture de La Langue maternelle ([1995] 2006), cet article se propose de montrer comment Alexakis actualise les potentialités que Roland Barthes attribuait au dictionnaire. Débordant son « ustensilité », il devient pour le narrateur de ce roman une véritable « machine à rêver », à la fois adjuvant et résultat de la quête de sa langue maternelle.

Fractures de la cheville chez le patient âgé [Ankle fractures in the elderly patient].

Ankle fractures in adults are usually managed by open reduction internal fixation. In elderly patients the surgical dilemma relates to bone quality. Osteoporosis is the enemy of internal fixation, and secure purchase of screws in osteopenic bone may be difficult to achieve. Insufficient screw purchase may lead to loss of reduction, wound breakdown, and infection. Postoperative management after osteosynthesis usually requires an extended period of restricted weight bearing. However, this is not feasible in older patients as a result of their lack of strength in the upper extremities and frequent comorbidities. Therefore, augmen- ted methods of internal fixation and specific surgical techniques have been developed using metal and bone cement. This permits this fragile population to begin early full weight bearing in a removable brace.

Apical access and closure devices for transapical transcatheter heart valve procedures.

The majority of transcatheter aortic valve implantations, structural heart procedures and the newly developed transcatheter mitral valve repair and replacement are traditionally performed either through a transfemoral or a transapical access site, depending on the presence of severe peripheral vascular disease or anatomic limitations. The transapical approach, which carries specific advantages related to its antegrade nature and the short distance between the introduction site and the cardiac target, is traditionally performed through a left anterolateral mini-thoracotomy and requires rib retractors, soft tissue retractors and reinforced apical sutures to secure, at first, the left ventricular apex for the introduction of the stent-valve delivery systems and then to seal the access site at the end of the procedure. However, despite the advent of low-profile apical sheaths and newly designed delivery systems, the apical approach represents a challenge for the surgeon, as it has the risk of apical tear, life-threatening apical bleeding, myocardial damage, coronary damage and infections. Last but not least, the use of large-calibre stent-valve delivery systems and devices through standard mini-thoracotomies compromises any attempt to perform transapical transcatheter structural heart procedures entirely percutaneously, as happens with the transfemoral access site, or via a thoracoscopic or a miniaturised video-assisted percutaneous technique. During the past few years, prototypes of apical access and closure devices for transapical heart valve procedures have been developed and tested to make this standardised successful procedure easier. Some of them represent an important step towards the development of truly percutaneous transcatheter transapical heart valve procedures in the clinical setting.