Options chirurgicates pour l'insuffisance cardiaque terminale [Surgical options for terminal heart failure]

Terminal heart failure can be the cause or the result of major dysfunctions of the organisms. Although, the outcome of the natural history is the same in both situations, it is of prime importance to differentiate the two, as only heart failure as the primary cause allows for successful mechanical circulatory support as bridge to transplantation or towards recovery. Various objective parameters allow for the establishment of the diagnosis of terminal heart failure despite optimal medical treatment. A cardiac index <2.0 l/min, and a mixed venous oxygen saturation <60%, in combination with progressive renal failure, should trigger a diagnostic work-up in order to identify cardiac defects that can be corrected or to list the patient for transplantation with/without mechanical circulatory support.

Comparison of time-lapse GPR data collected under natural and forced infiltration conditions to estimate vadose zone hydraulic parameters

Time-lapse crosshole ground-penetrating radar (GPR) data, collected while infiltration occurs, can provide valuable information regarding the hydraulic properties of the unsaturated zone. In particular, the stochastic inversion of such data provides estimates of parameter uncertainties, which are necessary for hydrological prediction and decision making. Here, we investigate the effect of different infiltration conditions on the stochastic inversion of time-lapse, zero-offset-profile, GPR data. Inversions are performed using a Bayesian Markov-chain-Monte-Carlo methodology. Our results clearly indicate that considering data collected during a forced infiltration test helps to better refine soil hydraulic properties compared to data collected under natural infiltration conditions

A study of the cambial zone and conductive phloem of common beech (Fagus sylvatica L.) using an image analysis method. I. Influence of tree age on the structure

Quantification is a major problem when using histology to study the influence of ecological factors on tree structure. This paper presents a method to prepare and to analyse transverse sections of cambial zone and of conductive phloem in bark samples. The following paper (II) presents the automated measurement procedure. Part I here describes and discusses the preparation method, and the influence of tree age on the observed structure. Highly contrasted images of samples extracted at breast height during dormancy were analysed with an automatic image analyser. Between three young (38 years) and three old (147 years) trees, age-related differences were identified by size and shape parameters, at both cell and tissue levels. In the cambial zone, older trees had larger and more rectangular fusiform initials. In the phloem, sieve tubes were also larger, but their shape did not change and the area for sap conduction was similar in both categories. Nevertheless, alterations were limited, and demanded statistical analysis to be identified and ascertained. The physiological implications of the structural changes are discussed.

Controls on ostracod valve geochemistry, Part 1: Variations of environmental parameters in ostracod (micro-)habitats

The variations of environmental conditions (T°, pH, δ13CDIC, [DIC], δ18O, Mg/Ca, and Sr/Ca) of ostracod habitats were examined to determine the controls of environmental parameters on the chemical and isotopic composition of ostracod valves. Results of a one-year monitoring of environmental parameters at five sites, with depths of between 2 and 70 m, in Lake Geneva indicate that in littoral to sub-littoral zones (2, 5, and 13 m), the chemical composition of bottom water varies seasonally in concert with changes in temperature and photosynthetic activity. An increase of temperature and photosynthetic activity leads to an increase in δ13C values of DIC and to precipitation of authigenic calcite, which results in a concomitant increase of Mg/Ca and Sr/Ca ratios of water. In deeper sites (33 and 70 m), the composition of bottom water remains constant throughout the year and isotopic values and trace element contents are similar to those of deep water within the lake. The chemical composition of interstitial pore water also does not reflect seasonal variations but is controlled by calcite dissolution, aerobic respiration, anaerobic respiration with reduction of sulphate and/or nitrate, and methanogenesis that may occur in the sediment pores. Relative influence of each of these factors on the pore water geochemistry depends on sediment thickness and texture, oxygen content in bottom as well as pore water. Variations of chemical compositions of the ostracod valves of this study vary according to the specific ecology of the ostracod species analysed, that is its life-cycle and its (micro-)habitat. Littoral species have compositions that are related to the seasonal variations of temperature, δ13C values of DIC, and of Mg/Ca and Sr/Ca ratios of water. In contrast, the compositions of profundal species are largely controlled by variations of pore fluids along sediment depth profiles according to the specific depth preference of the species. The control on the geochemistry of sub-littoral species is a combination of controls for the littoral and profundal species as well as the specific ecology of the species.

Performance de l'estimation du poids foetal par echographie pour les foetus < or = 2000 g et les macrosomes (> or = 4000 g) [Performance of ultrasound estimation of fetal weight in fetuses weighing < or = 2000 g and more than 4000 g].

Decreasing perinatal morbidity and mortality is one of the main goals of obstetrics. Prognosis of preterm births depends on gestational age and birthweight. Multidisciplinary management is discussed with the parents according to these two parameters. In other circumstances, a suspected macrosomy will influence the management of the last weeks of pregnancy. Induction of labor or Cesarean delivery will be considered to avoid shoulder dystocia, brachial plexus injury or perinatal asphyxia. Birthweight needs to be estimated with accuracy, and this article describes the efficiency of various ultrasound weight estimation formulae for small and large fetuses.

Community introduction of practice parameters for autistic spectrum disorders: Advancing early recognition.

OBJECTIVES: Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2 year implementation program of Practice Parameters, aimed principally at improving early detection and intervention. METHOD: We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region. RESULTS: PP development and parallel information strategies resulted in a significant decrease of 1.5 years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient. CONCLUSION: Despite the encouraging improvement in mean-age-at-diagnosis 2 years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs.

Suitability, success and sinks: how do predictions of nesting distributions relate to fitness parameters in high arctic waders?

AimAlthough habitat suitability maps derived from species distribution models (SDMs) are often assumed to highlight locations that can sustain healthy populations over time, the relationship between suitability scores and fitness parameters has rarely been tested thoroughly. LocationZackenberg Valley, north-east Greenland. MethodsUsing 14years of data (1997-2010) representing three wader species (dunlin Calidris alpina, sanderling Calidris alba and ruddy turnstone Arenaria interpres), we tested the relationships between modelled suitability and fitness parameters at nesting locations. ResultsAmong the three species examined, only the ruddy turnstone exhibited significant relationships between suitability and nest success, but over time rather than space. During years with extensive snow cover in the landscape, the nesting sites of ruddy turnstone occurred in different habitats than were typically used across years. Moreover, in years with extensive snow cover, the ruddy turnstone initiated nests later and suffered from higher egg predation rates. Main conclusionOur results suggest that SDMs derived from species occurrences that include years of low reproductive success may over-estimate the potential suitable habitat in the landscape. Whenever possible, variation in reproductive success should be considered when building models to inform species' response to environmental change. species' response to environmental change.

Effective size of two feral domestic cat populations (Felis catus L): effect of the mating system.

A variety of behavioural traits have substantial effects on the gene dynamics and genetic structure of local populations. The mating system is a plastic trait that varies with environmental conditions in the domestic cat (Felis catus) allowing an intraspecific comparison of the impact of this feature on genetic characteristics of the population. To assess the potential effect of the heterogenity of males' contribution to the next generation on variance effective size, we applied the ecological approach of Nunney & Elam (1994) based upon a demographic and behavioural study, and the genetic 'temporal methods' of Waples (1989) and Berthier et al. (2002) using microsatellite markers. The two cat populations studied were nearly closed, similar in size and survival parameters, but differed in their mating system. Immigration appeared extremely restricted in both cases due to environmental and social constraints. As expected, the ratio of effective size to census number (Ne/N) was higher in the promiscuous cat population (harmonic mean = 42%) than in the polygynous one (33%), when Ne was calculated from the ecological method. Only the genetic results based on Waples' estimator were consistent with the ecological results, but failed to evidence an effect of the mating system. Results based on the estimation of Berthier et al. (2002) were extremely variable, with Ne sometimes exceeding census size. Such low reliability in the genetic results should retain attention for conservation purposes.

Profils de réponse immunitaire innée et adaptative lors d'infections aiguës par le virus de l'hépatite B, de la dengue et influenza A

Les réponses immunitaires innées et adaptatives déclenchées par une infection virale chez l'humain sont classiquement décrites comme une succession d'événements communs à tous les virus- la réponse innée, caractérisés par la libération rapide de cytokines antivirales et des chémokines, recrutant monocytes, NK et lymphocytes Τ vers le site d'infection, suivis par l'activation de l'immunité adaptative. Notre compréhension de la dynamique de ces mécanismes dynamiques est limitée chez l'humain. En effet, il existe peu d'études portant sur la cinétique et l'analyse quantitative de la réponse Τ spécifique au virus, parallèlement aux aspects plus qualitatifs de cette réponse (cytokines sériques produites lors de différentes infections virales, notamment). Méthode: Nous avons étudiés trois groupes de patients tous recrutés au cours de la phase aiguë d'une infection par le virus de la dengue (28 patients), le virus influenza A (13 patients) et le virus de l'hépatite Β (HBV) (13 patients). Nous avons analysé le profil d'activation (CD38, HLA-DR) et de prolifération (Ki-67, Bcl-2) des lymphocytes Τ CD8+ (par cytométrie de flux), de façon longitudinale à différents timepoints (depuis le début des symptômes jusqu'à rémission totale) en quantifiant 15 cytokines et chémokines (par Luminex multiplex biométrie immunoassay) dans le sérum des patients infectés. Résultats: Nous avons comparé le profil des réponses innée et adaptative chez les 3 types d'infection virales; les patients infectés par l'HBV ont une fréquence élevée de CD8+ spécifiques activés et proliférant ainsi que des taux sériques élevés de TNF-α et d'IFN-γ. Les patients infectés par le virus de la dengue et par le virus Influenza présentent quant à eux une activation CD 8+ moins intense mais une forte expression de la réponse innée, marquée par une élévation des cytokines IFN-α, IFN-γ, et TNF-α. De plus, une particularité des patients infectés par le virus de la dengue est de présenter une élévation marquée des cytokines immunorégulatrices (IL-10, IL- 1RA). Conclusion: Ces résultats permettent de montrer que la réponse immunologique consécutive à une infections virale spécifique est caractérisée par sa propre signature, tant au niveau de la production de cytokines/chemokines que de la quantité des lymphocytes Τ CD+8+ spécifiques activés et proliférantes. Ce travail contribue ainsi à une meilleure compréhension de l'immunité antivirale chez les humains, grâce à la description de la cinétique et de la quantification des cellules Τ CD8+ activées et des taux de cytokines dans chaque infection étudiée. Abstract Knowledge of innate and adaptive immune parameters triggered by viral infections is limited but important for understanding disease pathogenesis. We performed a comparative longitudinal analysis of serum cytokines/chemokines and of virus-activated CD8 Τ cells population in patients with acute dengue, influenza A or HBV infections from onset to disease recovery. We observed that each viral infection is characterized by its own signature of cytokines/chemokines production and size of activated and proliferating CD8 Τ cell pool. This is, to our knowledge, the first comparative longitudinal study of the immune response in human subjects in three distinct viral infections.

Assessment of liver tumor response by high-field (3T) MRI after radiofrequency ablation: Short- and mid-term evolution of diffusion parameters within the ablation zone.

PURPOSE: To compare the apparent diffusion coefficient (ADC) values of malignant liver lesions on diffusion-weighted MRI (DWI) before and after successful radiofrequency ablation (RF ablation). MATERIALS AND METHODS: Thirty-two patients with 43 malignant liver lesions (23/20: metastases/hepatocellular carcinomas (HCC)) underwent liver MRI (3.0T) before (<1month) and after RF ablation (at 1, 3 and 6months) using T2-, gadolinium-enhanced T1- and DWI-weighted MR sequences. Jointly, two radiologists prospectively measured ADCs for each lesion by means of two different regions of interest (ROIs), first including the whole lesion and secondly the area with the visibly most restricted diffusion (MRDA) on ADC map. Changes of ADCs were evaluated with ANOVA and Dunnett tests. RESULTS: Thirty-one patients were successfully treated, while one patient was excluded due to focal recurrence. In metastases (n=22), the ADC in the whole lesion and in MRDA showed an up-and-down evolution. In HCC (n=20), the evolution of ADC was more complex, but with significantly higher values (p=0.013) at 1 and 6months after RF ablation. CONCLUSION: The ADC values of malignant liver lesions successfully treated by RF ablation show a predictable evolution and may help radiologists to monitor tumor response after treatment.

L'analyse des renvois régionaux et interrégionaux en pratique médicale ambulatoire. [Analysis of regional and interregional referrals in ambulatory medical practice].

This article examines, in two Swiss cantons, the interdependence from a medical care point of view of various regions (health planning zones in one canton, political districts in the other). The volume and the destination of patient referrals prescribed by physicians in ambulatory practice are analyzed. The available data (on 1609 referrals) were gathered by the practitioners themselves, during a National Ambulatory Medical Care Survey type study in February-March 1981, in which 203 physicians participated. Several indicators are proposed (including an integration coefficient and an attraction coefficient for each zone); they show marked differences among the regions. This dynamic approach, based on the effective behavior of physicians, appears to be of major interest for health planning purposes (as compared with the frequent practice to use mainly parameters in relation with the availability of care services--the "supply"--numbers of professionals and/or health facilities).

Does T Helper Differentiation Correlate with Resistance or Susceptibility to Infection with L. major? Some Insights From the Murine Model.

The murine model of Leishmania major infection has been an invaluable tool in understanding T helper differentiation in vivo. The initial evidence for a role of distinct CD4(+) T helper subsets in the outcome of infection was first obtained with this experimental model. The development of CD4(+) Th1 cells was associated with resolution of the lesion, control of parasite replication, and resistance to re-infection in most of the mouse strains investigated (i.e., C57BL/6). In contrast, differentiation of CD4(+) Th2 cells correlated with the development of unhealing lesions, and failure to control parasite load in a few strains (i.e., BALB/c). Since these first reports, an incredible amount of effort has been devoted to understanding the various parameters involved in the differentiation of these, and more recently discovered T helper subsets such as Th17 and T regulatory cells. The discovery of cross-talk between T helper subsets, as well as their plasticity force us to reevaluate the events driving a protective/deleterious T helper immune response following infection with L. major in mice. In this review, we describe the individual contributions of each of these CD4(+) T helper subsets following L. major inoculation, emphasizing recent advances in the field, such as the impact of different substrains of L. major on the pathogenesis of disease.

Contribution pollinique à l'étude du pléistocène de la région lémanique (Suisse) : paléoenvironnement des derniers 800'000 ans

Abstact : Pollinic contribution to a Pleistocene study of the Lake Geneva region (Switzerland) Palaeoenvironment of the last 800,000 years. Although the "Plateau Romand" (tableland of French-speaking Switzerland) has been marked by the repetitive action of different Quaternary glacial thrusts, numerous preserved outcrops here and there, thanks to favourable topographical conditions, provide sufficient pollinic content to reconstitute the significant botanical fluctuations and allow bio- and chrono-stratigraphical correlations with the long European sequences. The present study examines around ten Pleistocene deposits rich in pollens, whose presumed ages cover a range of 800,000 years. - The Early and Early-Middle Pleistocene are examined at Ecoteaux (VD), undeniably the oldest site in this study. The "Lower Formation of Ecoteaux", whose low pollinic content reveals an environment of the cold desert type, shows an inverse palaeomagnetic remanence. An age earlier than 780,000 years BP (Matuyama period or earlier) is proposed. The "Upper Formation of Ecoteaux" contains over eight major fluctuations in the vegetal covering, of which at least four temporal phases and one climatic optimum. The presence of botanical genera, relics of the Tertiary in particular Pterocarya and Carya, associated with the vegetal dynamic made up of short oscillations, contrives to link this formation to the Cromerian Complex. The thermomeres recorded could correspond to one or several interglacial periods from Middle Pleistocene. Possible correlations with marine isotopic stages 15, 17 and 19 are discussed. - The Middle and Late Pleistocene is approached through the sediments of Onnens (VD), Creux d'Enfer (FR), Port-Valais (VS), La Dénériaz (VD) and Cortaillod (NE). Each site provides a temperate interglacial flora, whose pollinic content is evaluated according to the different conceivable bio-stratigraphic correlations. - Finally the Würm is studied thanks to the outcrop of Marly (FR), together with the excavations at Villars-sous-Yens (VD), Versoix (GE) and Ollon (VD). Together, these observations tend to show that the west of the Swiss Plateau is a zone of transition between the meridian vegetation of the lower Rhone valley and that of beyond the Jura. At the outlet of the Rhone glacier, and on the borders of the prealpine and Jurassian glaciers, the region is situated at the crossroads of post-glacial botanical migrations, between the major axis of the Rhone valley and the Eastern refuge zones; this situation confers particular importance on it. Although believed to be deeply scraped by ice, one notices today that the "Plateau Romand" harbours overtwenty interglacial and interstadial sites. The abrasive action of the Rhone glacier has thus been more modest than previously estimated. The effective extension of glacial tongues, together with atmospheric circulation, are doubtless varying from one interglacial to another. Finally, the speeds of glacial movements, and the unbelievable vegetal vitality, are important parameters, capable of leading to deposits, very early enriched in pollens. RÉSUMÉS : Contribution pollinique à l'étude du Pléistocène de la région lémanique (Suisse) - Paléoenvironnement des derniers 800'000 ans Bien que le Plateau romand soit marqué par l'action répétitive des différentes poussées glaciaires quaternaires, de nombreux affleurements préservés ça et là, à la faveur de conditions topographiques favorables, livrent un contenu pollinique suffisant pour reconstituer des fluctuations botaniques significatives et autoriser des corrélations bioet chronostratigraphiques avec les longues séquences européennes. Le présent travail étudie une dizaine de dépôts pléistocènes riches en pollens, dont les âges présumés balaient un éventail de plus de 800'000 ans. - Le Pléistocène Ancien et Moyen inférieur, sont examinés à Ecoteaux (VD); indéniablement le site le plus ancien de cette étude. La "Formation inférieure d'Ecoteaux", dont le maigre contenu pollinique traduit un environnement de type désertique froid, présente une rémanence magnétique inverse. Un âge antérieur à 780'000 ans BP (période de Matuyama ou antérieure) est proposé. La "Formation supérieure d'Ecoteaux" comprend plus de huit fluctuations majeures du couvert végétal, parmi lesquelles on compte au moins quatre épisodes tempérés et un optimum climatique. La présence de genres botaniques reliques du Tertiaire, en particulier Pterocarya et Carya, associée à la dynamique végétale faite de courtes oscillations, concourent à lier cette formation au Complexe Cromérien. Les thermomères enregistrées pourraient correspondre à un- ou plusieurs interglaciaires du Pléistocène moyen. Les corrélations possibles avec les stades isotopiques marins, MIS 15, 17 et 19 sont discutées. - Le Pléistocène Moyen et Récent est abordé à travers les sédiments d'Onnens (VD), du Creux d'Enfer (FR), de Port-Valais (VS), de La Dénériaz (VD) et de Cortaillod (NE). Chaque site livre une flore tempérée interglaciaire, dont le contenu pollinique est évalué en fonction des différentes corrélations bio-stratigraphiques envisageables. - Enfin le Würm est étudié grâce à l'affleurement de Marly (FR), accompagné des forages de Villars-sous-Yens (VD), Versoix (GE) et Ollon (VD). L'ensemble de ces observations tend à montrer que l'ouest du Plateau suisse est une zone charnière entre la végétation méridionale de la basse vallée du Rhône et celle d'au-delà du Jura. Au débouché du glacier du Rhône et aux confins des glaciers préalpins et jurassiens, cette région est située au carrefour des migrations botaniques post-glaciaires, entre l'axe majeur de la vallée du Rhône et les zones refuges de l'Est. Cette situation lui confère une importance toute particulière. Alors qu'on pensait le Plateau romand profondément raboté par les glaces, on constate aujourd'hui qu'il recèle plus d'une vingtaine de sites interglaciaires et interstadiaires. L'action abrasive du glacier rhodanien a donc été plus modeste qu'envisagée jusqu'ici. L'extension effective des langues glaciaires, tout comme la circulation atmosphérique, diffèrent sans doute d'un interglaciaire à l'autre. Enfin la vitesse des mouvements glaciaires et l'incroyable vitalité végétale sont des paramètres importants, susceptibles d'avoir entraîné des dépôts, très précocement enrichis en pollens.

Les coûts des dommages éléments naturels aux bâtiments et l'influence des facteurs du risque dans un contexte d'assurance immobilière : analyse de cas des innondations et de la grêle en Suisse

In Switzerland, the annual cost of damage by natural elements has been increasing for several years despite the introduction of protective measures. Mainly induced by material destruction building insurance companies have to pay the majority of this cost. In many European countries, governments and insurance companies consider prevention strategies to reduce vulnerability. In Switzerland, since 2004, the cost of damage due to natural hazards has surpassed the cost of damage due to fire; a traditional activity of the Cantonal Insurance company (EGA). Therefore, the strategy for efficient fire prevention incorporates a reduction of the vulnerability of buildings. The thesis seeks to illustrate the relevance of such an approach when applied to the damage caused by natural hazards. It examines the role of insurance place and its involvement in targeted prevention of natural disasters. Integrated risk management involves a faultless comprehension of all risk parameters The first part of the thesis is devoted to the theoretical development of the key concepts that influence risk management, such as: hazard, vulnerability, exposure or damage. The literature on this subject, very prolific in recent years, was taken into account and put in perspective in the context of this study. Among the risk parameters, it is shown in the thesis that vulnerability is a factor that we can influence efficiently in order to limit the cost of damage to buildings. This is confirmed through the development of an analysis method. This method has led to the development of a tool to assess damage to buildings by flooding. The tool, designed for the property insurer or owner, proposes several steps, namely: - Vulnerability and damage potential assessment; - Proposals for remedial measures and risk reduction from an analysis of the costs of a potential flood; - Adaptation of a global strategy in high-risk areas based on the elements at risk. The final part of the thesis is devoted to the study of a hail event in order to provide a better understanding of damage to buildings. For this, two samples from the available claims data were selected and analysed in the study. The results allow the identification of new trends A second objective of the study was to develop a hail model based on the available data The model simulates a random distribution of intensities and coupled with a risk model, proposes a simulation of damage costs for the determined study area. Le coût annuel des dommages provoqués par les éléments naturels en Suisse est conséquent et sa tendance est en augmentation depuis plusieurs années, malgré la mise en place d'ouvrages de protection et la mise en oeuvre de moyens importants. Majoritairement induit par des dégâts matériels, le coût est supporté en partie par les assurances immobilières en ce qui concerne les dommages aux bâtiments. Dans de nombreux pays européens, les gouvernements et les compagnies d'assurance se sont mis à concevoir leur stratégie de prévention en termes de réduction de la vulnérabilité. Depuis 2004, en Suisse, ce coût a dépassé celui des dommages dus à l'incendie, activité traditionnelle des établissements cantonaux d'assurance (ECA). Ce fait, aux implications stratégiques nombreuses dans le domaine public de la gestion des risques, résulte en particulier d'une politique de prévention des incendies menée efficacement depuis plusieurs années, notamment par le biais de la diminution de la vulnérabilité des bâtiments. La thèse, par la mise en valeur de données actuarielles ainsi que par le développement d'outils d'analyse, cherche à illustrer la pertinence d'une telle approche appliquée aux dommages induits par les phénomènes naturels. Elle s'interroge sur la place de l'assurance et son implication dans une prévention ciblée des catastrophes naturelles. La gestion intégrale des risques passe par une juste maîtrise de ses paramètres et de leur compréhension. La première partie de la thèse est ainsi consacrée au développement théorique des concepts clés ayant une influence sur la gestion des risques, comme l'aléa, la vulnérabilité, l'exposition ou le dommage. La littérature à ce sujet, très prolifique ces dernières années, a été repnse et mise en perspective dans le contexte de l'étude, à savoir l'assurance immobilière. Parmi les paramètres du risque, il est démontré dans la thèse que la vulnérabilité est un facteur sur lequel il est possible d'influer de manière efficace dans le but de limiter les coûts des dommages aux bâtiments. Ce raisonnement est confirmé dans un premier temps dans le cadre de l'élaboration d'une méthode d'analyse ayant débouché sur le développement d'un outil d'estimation des dommages aux bâtiments dus aux inondations. L'outil, destiné aux assurances immobilières, et le cas échéant aux propriétaires, offre plusieurs étapes, à savoir : - l'analyse de la vulnérabilité et le potentiel de dommages ; - des propositions de mesures de remédiation et de réduction du risque issues d'une analyse des coûts engendrés par une inondation potentielle; - l'adaptation d'une stratégie globale dans les zones à risque en fonction des éléments à risque. La dernière partie de la thèse est consacrée à l'étude d'un événement de grêle dans le but de fournir une meilleure compréhension des dommages aux bâtiments et de leur structure. Pour cela, deux échantillons ont été sélectionnés et analysés parmi les données de sinistres à disposition de l'étude. Les résultats obtenus, tant au niveau du portefeuille assuré que de l'analyse individuelle, permettent de dégager des tendances nouvelles. Un deuxième objectif de l'étude a consisté à élaborer une modélisation d'événements de grêle basée sur les données à disposition. Le modèle permet de simuler une distribution aléatoire des intensités et, couplé à un modèle d'estimation des risques, offre une simulation des coûts de dommages envisagés pour une zone d'étude déterminée. Les perspectives de ce travail permettent une meilleure focalisation du rôle de l'assurance et de ses besoins en matière de prévention.