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J. - P.C.: Our guideline is often random, in any case mine was the fruit of very different events. One could think that I owe my guideline with my father who was surgeon pediatrist general practitioner in the private one. It was then interested in the csotcina.comedic surgery in the handicapped child and devoted the fifteen last years of its surgical life to the center Paul or it had taken full-time to deal with the . Actually, I owe him surely my medical guideline, but at the beginning of boarding school, when I came to help it, I was not attracted by this very specialized surgery. It is only much later that I started to find an interest there. In fact, my csotcina.comedic guideline was born from my meeting in 1969 with Christian who was senior registrar in the adult csotcina.comedic department of the Instructor . At the time of this training course of intern, it made me discover the immediate effectiveness of our work in traumatology and the extraordinary potential of the prostheses. But my choice of an adult career of csotcina.comedist was of short duration because at the end of the training course, when I requested a post of from Mr , he announced to me that he had given the item 3 days earlier to one of my comrades of boarding school. Finally, they are only nths later, when I passed in the infantile surgery department of Mr , that, allured by the pediatric csotcina.comedics, I decided to engage me in this channel. In 1973, I became senior registrar of surgery infantile and that made now 33 years that I am in this service. There is thus a great part of chance in my surgical guideline. . But were you a surgeon pediatrist or an csotcina.comedist pediatrist? J. - P.C.: When I arrived as senior registrar, we made in Toulouse pediatric general surgery. I.e. during my the first 4 years of we discuss as well a congenital hip dislocation as a of the esophagus. But the pediatric surgery becoming increasingly specific I had the chance that Mr accepts, under the pressure of the whole of the surgeons pediatrists of the service, to divide his service into two different entities with guideline. It should be said that it had itself a very marked csotcina.comedic guideline. We thus followed rather quickly what did not exist whereas in some hospitals in France, and thus I became as from 1978 an csotcina.comedist “nonofficial” pediatrist. . : What understand by csotcina.comedist “nonofficial” pediatrist? J. - P.C.: “Nonofficial” because neither the university authorities nor the national council of the command recognize us. Officially, we are surgeons pediatrists being able to make all the surgery of the child. This “battle” for the reconnaissance of the pediatric csotcina.comaedics began in 1979. It was carried out by the five charter members of the but it is still not finished. We have however good hope to quickly obtain the reconnaissance of teams distinct from pediatric csotcina.comaedics and of pediatric visceral surgery because this differentiation is today a need. Indeed, this partition exists in all Europe, and which more is, the of pediatric surgery requires of us to organize in the centers of specialities for child a separate guard of visceral surgery and pediatric csotcina.comedics. This last argument is a strong element for the future of our speciality to attract young people as well as to create the posts necessary to the installation of this activity of guard. . : What remains to be made to obtain this reconnaissance? J. - P.C.: Currently, we are recognized as an csotcina.comedist pediatrist by the community of the csotcina.comedic surgeons and that of the surgeons visceral pediatrists. But the absence of official recognition of this specificity makes our position extremely fragile with respect to the even university or ordinal hospital administration. Indeed, as the hospital contests do not take into account this specificity, the results of these contests can be random. Moreover, Faculties always do not make the difference between our guidelines what enables them to have one teacher to ensure an overall formation. However each one knows for a long time that one teaches although what one practices regularly. . In practice, which are your aims? J. - P.C.: We think that we must engage in the reform of the : we will propose with our university supervision to recognize a of infantile surgery with 2 different guidelines, one with visceral guideline and the other with csotcina.comedic guideline. This would allow set up a formation containing of the specific modules which would be copied on those of the adult csotcina.comedists. Thus, in the long term, if we arrive at our aim, we will have given up the general surgery definitively to bring us closer to the csotcina.comedists. . : But, training in pediatric csotcina.comaedics must it be specific? J. - P.C.: Yes because our formation is at the same time different from that of a pediatric surgeon visceral and complementary to that of an adult csotcina.comedist. It is obvious that the technological blossoming of these 20 last years does not make it possible any more to train a surgeon pediatrist general practitioner. The development of the , the development of osteosynthesis, the biomaterials and the prostheses, but also the appearance of the surgery computer-assisted or the percutaneous surgery, completely amended our techniques and our indications. Each one of these innovations requires a formal training and practical specific which is not compatible any more with the acquisition of other necessary technologies to the practice of the visceral surgery. So part of our formation is copied on that of the adult csotcina.comedists, but is different from it by data acquisition specific to the child. It is necessary that the surgeon pediatrist with csotcina.comedic guideline has a model of formation similar to that of the adult csotcina.comedists and that one keeps this exceptional model of formation which the doubles adult-child represent. But for that, it is necessary to acquire a true pediatric specificity. . : What please tell itself by there? J. - P.C.: I want to say that three aspects differentiate us: On the one hand, the pediatric csotcina.comaedics represent the application of techniques which result from a reflection on the growth; this aspect there is learned rather quickly. In addition, the pediatric csotcina.comaedics are made of a sum of typical examples which gives to the experiment a great role in the indications. Of this fact the training of an csotcina.comedist pediatrist is very long. Lastly, the pediatric csotcina.comaedics deal with pathologies as different as the congenital hand or the scoliosis from the adolescent, in children whose age extends from new born with the adolescent. It is thus requested from the csotcina.comedists general practitioners that we are, to know to control very different techniques. And this still takes much time. To summarize these remarks, I would quote the sentence of Jean who with the practice to tell, which “they are the patients who taught him his trade”. This sentence correctly translates the share of the experiment and time in the training of an csotcina.comedist pediatrist. . : But do you hope to remain csotcina.comedists general practitioners? J. - P.C.: Certainly, because there exists a basic traumatology and csotcina.comedy that everyone must share. The problem is more complex when one addresses oneself to rare pathologies like the malignant neoplasms, certain congenital malformations or uncommon diseases. It is probably interesting dice to today concentrate them on only one individual within a team or of an area. . : But how? J. - P.C.: We have three possibilities: either we will increase the number of csotcina.comedists pediatrists and that wants to say that we will have convinced the hospital community of our needs, or we will share with our adult colleagues, an csotcina.comedist specialized in a field, but it will be necessary that the time-sharing or equitable, or we will carry out a reflection of policy inter regional of the pediatric csotcina.comaedics. But what is sure it is that we will not escape this reflection. It is even a fundamental question for our future and for my part I will be favorable to a medical policy on the level of inter area. . : Think that there is a future with the pediatric csotcina.comaedics? J. - P.C.: Yes, because we will not return towards mixed services adult-children. There are facts impossible to circumvent in favor of the pediatric csotcina.comaedics, provided that it adapts to the technological advancements. Initially, it is created in Europe and in all the French areas of the hospital Mother-Children testifying to the will of a capture in specific charge of the child. But attention, these hospitals will be viable only if they are coupled with the technical plate of the adults. Then, there exists a service request specialized as well on behalf of the families as of our colleagues. But for that, we will have to change mentality. We will have to form part of true unities of medico-surgical csotcina.comedy. In addition, the genetics or the installation of processing like botulinic toxin or the already amended our practices and we will have to work in one multi-field system to even more offer the quality which one will require of us. And this brings back for us towards the need for an agreement on the level of the areas. . : You seem to be very attached to the concept of hospital of children? J. - P.C.: Indeed. During 25 years I initially worked in a department of pediatric surgery located in a ship dedicated to the child. Now, for 8 years I have lived in a hospital designed for the children. This consolidated me in the founded good of the creation of such entities. Indeed, so when designing these hospital, the child and his medical environment are in the think tank you note very quickly that the human relationship with the family but also with the others looking after is of better quality. The gathering on the same place of all the children some is the affection but also the presence of, state education, area gaming rooms of medical indoctrination for the child and the family, reassures them. But as I said it previously this hospital of children should not be cut adult structures. I regret only that our hospital did not know to integrate all the specialities surgical for financial reasons or dependant on certain personalities. . : Which place do you give to search in the formation? J. - P.C.: At the time of my boarding school, I was likely to make a training course at Mr . It marked me much because it did not hesitate to call in question the dogmas of our trade. He always asked us “why” in front of what could appear obvious. It was the time or it was impassioned for the femoral head necrosis. Did one day, it show us 2 radiographies of an upper end of the femur and asked to us whether there were one necroses? Of course, we had not noted a difference. However a radiography was that of an inpatient and the other that of a mummy whose femoral head had not been vascularized any more for thousand years! Thus he convinced us that necroses it was not visible with the beginning. I think that it is during this training course that was born my desire for taking part in search in csotcina.comedy. . : How did you can take part in search on Toulouse? J. - P.C.: It was not very easy. But, with beginning of the year 80, we could, with Michel , to integrate structures of search. Initially, we worked in unity INSERM of the Instructor . It directed a unity and it accepted to open it with the set of themes of biomechanics. Thus with which was researcher INSERM, we realized thanks to the finite element method, the rebuilding 3D of the clubfeet whereas Michel rebuilt scapulas. Consequently this enabled me to validate the assumption of the external rotation of the in the clubfeet which in 1978 had imagined and to justify the technique of the csotcina.comedic processing of . In parallel, with Andre who is Instructor of surgery at the School Veterinary surgeon, we led an experimental research on the sheep with the purpose of studying the consequences on the growth of an asymmetrical pressure. This helped me with better understanding the phenomenon of beam to which we assist in the development of the frontal in the child. . : What did you appoint this time? J. - P.C.: Initially that to make search takes time. Consequently, one cannot make some either even as at the beginning of career because later one cannot undertake several activities any more at the same time. Then that we have all our place in laboratories whose members have a formation different and complementary to our. This co-education is extremely enriching and our presence makes it possible to the patient to remain in the think tank of these mixed laboratories. . : Do you continue? J. - P.C.: Not, but I a long time continued an administrative activity of “researcher of funds”. Also, when the team was about structured, we have with Mr. last the relay with our scientific colleagues. Today, we have a team of biomechanics which is directed by Pascal , Instructor of mechanics at the University Paul . It is in this team that work our interns and senior registrars under the medical joint management of J. Dirty of and Pierre and scientist of several mechanics. Today, my role is to try to wake up in the interns a certain curiosity to work in a laboratory. . : Do you still have implications in search? J. - P.C.: Not, although since 1996 with has and G , we set up the seminar of search in pediatric csotcina.comaedics. This seminar takes place every 2 years in alternation in each one of our cities. Of national it gradually became international. Its interest lies in the simultaneous presence of young csotcina.comedists and scientists. Their different formations enrich the debate. . : Summers you still interested by the clinical research? J. - P.C.: Of course, because one cannot have the responsibility for a unity without having an interest in the clinical research. However, over 30 years my centers of interests varied, which is probably not the best attitude, because while changing subject, one never looks further into really a topic whereas it continues to evolve/move. It is besides the force of certain Anglo-Saxons who always plow the same furrow during all their activity. Of another dimensioned, the renewal of the poles of interests holds you in awakening. Thus I am in order to it successive and sometimes simultaneous time, interested in the development of the of the child, the disease of or the equine clubfoot . It surely is too but that enabled me to continue to work with pleasure. . : Why you are you interested in the ? J. - P.C.: One day, I made the official report which I will not manage to abolish the consultations whose reason does not have any apparent interest such as the “feet which turn”, the genu valgum and flatfeet of the 4 year old child… Indeed, we see many children whose problem is at the border of physiological and the pathological one. I told myself that as long as to give my time I was to find an interest with these consultations. I thus tried to rationalize my examination, and to serve to me as these data to define the standards of the in the 3 plans of space. I thus noted that there was a multitude of normal people having very different . That enabled me to take retreat with respect to the rotational faults, while remaining fascinated by the acquisition of the in the child. . : Sums us all different? J. - P.C.: Yes, because the combination of the possibilities in the 3 plans is immense. One day, you stop and look at people making a jogging: you will be struck by the diversity of the movements that each one of these individuals realize for the same share. We know today only groups of individuals having a near, whereas the singularity of each one owes one being day taken into account if we want to define the share of each plan on the articular future. There is an immense work of stripping to make which will answer an individual operative technique that the surgery computer-assisted will allow. . : Within the framework of the , why be itself interested in the rotational faults? J. - P.C.: In fact, I inherited this subject because Mr worked on the femoral . At the time, in the service one worked all on this topic. Thus we continued his work, the ones in the laboratory of biomechanics, the others in clinical studies. It was initially Philippe Picart who took stock of the derotation osteotomies that Mr had realized for twenty years. Then, Jean Marc was the first to show in experiments the relation between torsion and amendment of the pressure on the patellar cartilage. Each one among us thus tried to bring its share to a better knowledge of these faults. For my part, it is thanks to these consultations “of maternal concerns” that I could characterize them and follow their developments. But, it does not remain about it less than I am still dissatisfied because this work is not completed since we still do not know their long-term future. . : Do you differently regret not having directed this work? J. - P.C.: The problem of the long-term future of the rotational faults is posed for a long time. In France, Mr , because he was an csotcina.comedist of adult and child, showed us cases of osteoarthritis on exaggerated femoral . But was there a direct relationship and unquestionable for all the cases? This proven forever. Today by associating the data of the analysis laboratories of the functioning and modeling one tries to provide for the future of these faults. But there are still too many unknown factors in our models so that they are reliable. Also, if I regret it is that not to have launched an exploratory study thirty years ago. Perhaps we would have an embryo of answer today but I acknowledge that this work would have been tiresome and it is probably the reason for which nobody carried it out. . : Do you use an analysis laboratory of the functioning? J. - P.C.: Yes, we spent 10 years to obtain an analysis laboratory of the functioning in the service. We initially started with a system with 2 cameras and a platform of functioning. This laboratory, installed in unity INSERM of another hospital, was far from pediatry and did not allow us to correctly analyze the children carrying a neurologic affection. Then during 5 years we analyzed the functioning of some children forwarding a rotational fault. This enabled us to correlate the angle of the pitch with the development of external tibial torsion during the growth. We then obtained complete equipment which was installed beside the consultations of pediatric csotcina.comaedics. Today, it became essential tools in the assumption of responsibility of the going. That enabled us to progress in our reflection, our indications and our operative techniques in these children. So one attends within the service the specialization of a multidisciplinary group which understands an csotcina.comedist, a and an engineer in biomechanics. More time passes more we profit from their teaching but contrary less each one among us deals with these children. One returns from there to the problem of the organization of the pediatric csotcina.comaedics which to progress must specialize more and more. . : It is felt that poses a problem to you? J. - P.C.: Indeed, at the beginning you create a team whose various members are interchangeable. Then with the technological progression you feel well that each one of them cannot any more all assume. Then you start with to specialize each member of this small team. But technology goes quickly and of new needs appear that you will not be able to fill. From where my fear to see the pediatric csotcina.comaedics bursting in pathology of part. For the moment, in our team, each one could find its “pre square” what enables him to be expressed and to live in independence while belonging to the group. But we will arrive at the end of this logic and we will have to make choices what is not to please to me. . : You speak about team and never about service. Why? J. - P.C.: Because for 9 years, the department of pediatric csotcina.comaedics of Toulouse has not been any more one entity but is integrated in a medico-surgical pole of pediatry made up of 10 teams of which those of pediatric csotcina.comedics. I thus resigned of my post of head of service 10 years ago to deal with the team of pediatric csotcina.comedics. My passage, 25 years ago in Anglo-Saxon structures had taught me that there were different systems that ours and that they functioned very well, even better. It is thus without regret that I left the conventional system to integrate a department into different operation. It seems to me that this system more the participants all in their making become aware that they belong at a community. The decisions are made by the whole of the doctors what links even more the teams. Lastly, it seems to me that it is easier than formerly of set up of the multidisciplinary connections which appear to me to have to be our future. At the bottom, this loss of territory is largely compensated by the improvement of the human relations and the valorization of the teams and competences. It should be also said that the good walk of this organization was supported by the creation of the hospital of the children whose design is based on the functionality. . : Do you have criticisms to make with this new organization? J. - P.C.: Not really. Of course, this organization did not abolish the relational problems between the doctors but they appear less because each one among us depends on the others in his operation. This inter relation obliges all the doctors to take part in operation. Thus, the almost obligatory participative system for each one, makes that the extremes are quickly pushed back. Finally, there exists an “average” route which is accepted by all because it makes it possible each one to correctly live. . : You spoke about your work in foreign structures. What is what that brought to you? J. - P.C.: For my period of boarding school then of , I had the chance that Mr pushes me to travel to France or abroad. I retained of it that there existed only relative truths in our trade. . : What do you want to tell in practice? J. - P.C.: I want to say that when you arrive from Toulouse to take part in your first training seminar in San Francisco organized by Mr. and that on the first transparency concerning the treatment of femoral shaft fractures you see a child in traction on which a panel of prohibited direction is projected, you known as that one can have on the same pathology of the opposite glances. I specify that thirty years after we continue to discuss the fractures of the femur in the children of less than 6 years by traction during 15 to 21 days. But the repetition of these differences learns how to you to adhere to all the ideas in condition which is argued and to be wary of the ideas stated from way peremptory. . : Finally does all go well to Toulouse? J. - P.C.: Yes because Toulouse is well as long as there is #FFFFFF on the Pyrenees, that the airspace belong to us and that the Stade Toulousain is as well as possible of its form. I like my city but also this sport because it is an excellent reflection of a life which puts forward the worship of the team, the friendship and the festival. I believe that all that is important because if our trade is enthralling, it is also necessary to know to leave there. . : Do you have to leave there? J. - P.C.: Of course, because I continue my childhood by seeking in the secondhand trades the miniature aircraft and in the secondhand booksellers the books illustrated for child. Moreover, I always seek the old books of pediatric csotcina.comaedics and I benefit from this occasion to launch the idea to discuss by the means of Internet with my colleagues csotcina.comedists of these old books.
csotcina.comedic control - November 2006
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