Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study.

BACKGROUND: Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of 1-year follow-up. METHODS AND MATERIALS: Between the years 2014-2015, we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. RESULTS: The mean preoperative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9-22.9). The mean preoperative IMA of the Chevron control group was 13.3 ± 2.3 (10.4-18.2) (p = 0.038). The mean IMA two weeks after the surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two-week and 1-year follow-up, there was no significant difference found in the IMA between the two groups (p = 0.871). The mean hallux valgus angle reduction was 11.85 ± 4.88 (3-20.8) and 11.09 ± 6.51 (- 1.1 to 22.5) in the SERI and Chevron groups, respectively (p = 0.69). Neither groups reported symptomatic transfer metatarsalgia throughout the follow-up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001); however, all other parameters with similar. CONCLUSION: The SERI technique provided comparable outcomes at up to 1-year follow-up when compared with a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus. LEVEL OF EVIDENCE: Level II Prospective Study. TRIAL REGISTRATION: Approved by local IRB at MMC.

COVID-19 and andrology: Recommendations of the French-speaking society of andrology (Société d'Andrologie de langue Française SALF).

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) metamorphosed our medical practice. In early June 2020, more than 6,400,000 COVID-19 (coronavirus-19 disease) cases were diagnosed across the world and more than 380,000 deaths were linked to COVID-19. Many medical symptoms of COVID-19 were reported. We will focus, here, on potential impacts of COVID-19 on men's andrological health. Our society (French-speaking society of andrology, SALF) also emitted some recommendations in the andrological management of men infected by SARS-CoV-2. First, considering the fever and the potential presence of SARS-CoV2 in semen, SALF recommends waiting for 3 months (duration of one spermatogenesis cycle and epididymal transit) before re-starting ART in the case of men diagnosed COVID-19 positive. Whatever the nature of testosterone and COVID-19 relationships, we recommend an andrological examination, sperm parameters, and hormonal evaluation at the time of the COVID-19 is diagnosed, and several months later. Furthermore, we are concerned by the potential morbid-mortality of the COVID-19, which mainly affects men. This "andrological bias", if proven, must be reduced by specific andrological diagnosis, therapeutic and prophylactic measures. Research in this direction must be substantiated and financially supported over the next few months (years).

Le SRAS-CoV-2 (nouveau coronavirus ou coronavirus numéro 2 responsable du syndrome respiratoire aigu sévère) a métamorphosé notre pratique médicale. Début juin 2020, plus de 6,400,000 cas de COVID-19 (maladie à coronavirus 2019) ont été diagnostiqués dans le monde et plus de 380,000 décès ont été reliés à cette maladie. De nombreux symptômes médicaux de cette infection virale ont été signalés. Nous nous concentrerons, ici, sur les impacts potentiels de COVID-19 sur la santé andrologique des hommes. Notre société (Société d'andrologie de langue Française, SALF) émet ici quelques recommandations dans la prise en charge andrologique des hommes infectés par le SRAS-CoV-2. Tout d'abord, compte tenu de la fièvre et de la présence potentielle du SRAS-CoV2 dans le sperme, la SALF recommande d'attendre 3 mois (durée d'un cycle de spermatogenèse et transit épididymaire) avant de recommencer les techniques d'assistance médicale à la procréation pour les hommes diagnostiqués COVID-19 positifs. Quelle que soit la nature des relations entre la testostérone et l'infection à SARS-CoV-2, nous recommandons un examen andrologique, un examen des paramètres du sperme et une évaluation hormonale au moment du diagnostic de l'infection, ainsi qu'à distance (3­6 mois plus tard). De plus, nous sommes préoccupés par la morbidité et la mortalité potentielles de l'infection COVID-19, qui touche principalement les hommes. Ce "biais andrologique", s'il est. prouvé, doit être réduit par un diagnostic andrologique spécifique et des mesures thérapeutiques et prophylactiques. La recherche dans ce sens doit être étayée et soutenue financièrement au cours des prochains mois (années).

Diagnosis associated with Tau higher than 1200 pg/mL: Insights from the clinical and laboratory practice.

CONTEXT: Cerebrospinal fluid (CSF) biomarkers are valuable tools for the diagnosis of neurological diseases. We aimed to investigate within a retrospective multicentric study the final diagnosis associated with very high CSF Tau levels and to identify patterns of biomarkers that would differentiate them in clinical practice, to help clinical biologists into physicians' counseling. PATIENTS AND METHODS: Within the national multicentric network ePLM, we included 1743 patients from January 1, 2008, to December 31, 2013, with CSF biomarkers assayed by the same Innotest assays (protein Tau, phospho-Tau [pTau], and Aß 1-42). We identified 205 patients with protein Tau concentration higher than 1200 pg/mL and final diagnosis. RESULTS: Among those patients, 105 (51.2%) were suffering from Alzheimer's disease, 37 (18%) from sporadic Creuztfeldt-Jakob disease, and 63 (30.7%) from other neurological diseases including paraneoplastic/ central nervous system tumor, frontotemporal dementia, other diagnoses, amyloid angiopathy, Lewy body dementia, and infections of the central nervous system. Phospho-Tau, Aß1-42 and Aß1-42/pTau values differed significantly between the three groups of patients (p < .001). An Aß1-42/pTau ratio between 4.7 and 9.7 was suggestive of other neurological diseases (threshold in AD: 8.3). CSF 14-3-3 was useful to discriminate Alzheimer's disease from Creuztfeldt-Jakob disease in case of Aß1-42 concentrations <550 pg/mL or pTau>60 pg/mL. CONCLUSION: This work emphasizes the interest of a well-thought-out interpretation of CSF biomarkers in neurological diseases, particularly in the case of high Tau protein concentrations in the CSF.

Dietary Onion or Ginger Modulates the Stress Response and Susceptibility to Vibrio harveyi JML1 Infection in Brown-marbled Grouper Epinephelus fuscoguttatus Juveniles.

Onion Allium cepa and ginger Zingiber officinale have health-promoting properties that qualify them as functional foods. The effect of repeated acute stressors was examined in juvenile Brown-marbled Grouper Epinephelus fuscoguttatus that were fed four diets supplemented with onion at 1.8%, ginger at 1.8%, vitamin C at 0.86%, and ß-glucan at 0.8% of the diet. The non-supplemented diet served as the control. After 12 weeks of feeding, fish were exposed to stressors and were experimentally infected with a fish pathogen, the bacterium Vibrio harveyi JML1. After repeated exposure to hypoxia, cortisol levels rose significantly in the non-supplemented fish compared to those fed onion, ginger, ß-glucan, or vitamin C. Within groups, postexposure cortisol levels in the onion-, ginger-, and vitamin C-fed fish did not change relative to pre-stress levels, whereas significant increases in poststress values were observed in the control and ß-glucan groups. The net cortisol increase was also significantly greater in the non-supplemented group compared to the supplemented groups. The net cortisol increase did not vary among the supplemented groups except that the ß-glucan-fed group exhibited a higher net increase than the onion-fed group. Similarly, repeated acute exposure to osmotic stress significantly increased the plasma cortisol level in the non-supplemented group compared to groups that received supplements; no differences were found in the supplemented groups except the ß-glucan group. Within groups, significant increases in poststress values relative to pre-stress levels were found only in the control and ß-glucan groups. Repeated acute exposure to hypoxia significantly increased cumulative mortality in the control group compared to the supplemented groups (except the ß-glucan group), whereas repeated exposure to acute osmotic stress significantly increased cumulative mortality only in the control group 10 d after infection with V. harveyi JML1. Based on our collective results, most of the supplemented groups performed better than the control, but the best supplements were onion and ginger in terms of enhancing stress tolerance and increasing survival of Brown-marbled Grouper upon infection with V. harveyi JML1.

[Alzheimer's disease cerebro-spinal fluid biomarkers: A clinical research tool sometimes useful in daily clinical practice of memory clinics for the diagnosis of complex cases]. / Les biomarqueurs du liquide cérébro-spinal dans la maladie d'Alzheimer : un outil de recherche utile dans la pratique clinique courante des consultations mémoire pour les cas complexes.

The role of biomarkers in clinical research was recently highlighted in the new criteria for the diagnosis of Alzheimer's disease. Cerebro-spinal fluid (CSF) biomarkers (total Tau protein, threonine 181 phosphorylated Tau protein and amyloid Aß1-42 peptide) are associated with cerebral neuropathological lesions observed in Alzheimer's disease (neuronal death, neurofibrillary tangle with abnormal Tau deposits and amyloid plaque). Aß1-40 amyloid peptide dosage helps to interpret Aß1-42 results. As suggested in the latest international criteria and the French HAS (Haute Autorité de santé) recommendations, using theses CSF biomarkers should not be systematic but sometimes could be performed to improve confidence about the diagnostic of Alzheimer's disease in young subjects or in complex clinical situations. Future biomarkers actually in development will additionally help in diagnostic process (differential diagnosis) and in prognostic evaluation of neurodegenerative diseases.

Effect of preemptive intra-articular morphine and ketamine on pain after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled study.

BACKGROUND: Rotator cuff tear is a leading etiology of shoulder pain and disability. Surgical treatment is indicated in patients with persistent pain who fail a trial of non-surgical treatment. Pain reduction following rotator cuff repair, particularly within the first 24-48 h, is a major concern to both doctors and patients. This study aimed to compare the postoperative antinociceptive additive effects of pre-incisional intra-articular (IA) ketamine when combined with morphine with two times the dose of morphine or saline. METHODS: In this prospective, randomized, double blind, controlled trial patients undergoing arthroscopic rotator cuff tear repair (ARCR) under general anesthesia were enrolled. Patients were randomly assigned to one of the three intervention groups. Twenty minutes prior to incision, morphine (20 mg/10 ml), ketamine (50 mg + morphine 10 mg/10 ml), or saline (0.9 % 10 ml) (n = 15/group), were administered to all patients. First 24 h postoperative analgesia consisted of intravenous patient controlled analgesia (IV-PCA) morphine and oral rescue paracetamol 1000 mg or oxycodone 5 mg. 24-h, 2-week and 3-month patient rated pain numeric rating scale (NRS) and analgesics consumption were documented. RESULTS: Patients' demographic and perioperative data were similar among all groups. The 24-h and the 2-week NRSs were significantly (p < 0.05) lower in both treatment groups compared to placebo, but were not significantly different between the two intervention groups. PCA-morphine and oral analgesics were consumed similarly among the groups throughout the study phases. CONCLUSIONS: Pre-incisional intra-articular morphine reduced pain in the first 2 weeks after arthroscopic rotator cuff repair. Further research is warranted to elucidate the optimal timing and dosing of IA ketamine and morphine for postoperative analgesic effects.

The radiological evaluation of the hip joint after prosthetic arthroplasty of the proximal femur in patients with a tumour using a bipolar femoral head.

Excision of the proximal femur for tumour with prosthetic reconstruction using a bipolar femoral head places a considerable load on the unreplaced acetabulum. We retrospectively reviewed the changes which occur around the affected hip joint by evaluating the post-operative radiographs of 65 consecutive patients who underwent proximal prosthetic arthroplasty of the femur, and in whom an acetabular component had not been used. There were 37 men and 28 women with a mean age of 57.3 years (17 to 93). Radiological assessment included the extent of degenerative change in the acetabulum, heterotopic ossification, and protrusio acetabuli. The mean follow-up was 9.1 years (2 to 11.8). Degenerative changes in the acetabulum were seen in three patients (4.6%), Brooker grade 1 or 2 heterotopic ossification in 17 (26%) and protrusion of the prosthetic head in nine (13.8%). A total of eight patients (12.3%) needed a revision. Five were revised to the same type of prosthesis and three (4.6%) were converted to a total hip arthroplasty. We conclude that radiological evidence of degenerative change, heterotopic ossification and protrusion occur in a few patients who undergo prosthetic arthroplasty of the proximal femur for tumour. The limited extent of these changes and the lack of associated symptoms do not justify the routine arthroplasty of the acetabulum in these patients.

Lateral epicondylitis treatment: international survey of surgeons' preferences and literature review.

BACKGROUND: Lateral epicondylitis (LE) is a common cause of elbow pain. Despite a relatively high prevalence and morbidity, there is still no single effective ('gold standard') treatment for LE. We hypothesised that a surgeon's experience, country of origin and area of expertise would influence choices concerning patient management. The purpose of this survey was to describe the current trends and common practices in treating LE worldwide. MATERIAL AND METHODS: A total of 291 orthopaedic surgeons of 12 subspecialties from 57 countries were surveyed on their choice of LE treatment modalities. Their preferences were analysed according to country of origin, field of expertise and seniority. The results were compared with current published level-1 evidence. RESULTS: The most popular modalities of treatment among all of the surveyed orthopaedic surgeons were non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid (CS) injection (38% of recommendations each). The most popular Modalities of treatment among the hand surgeons was NSAIDs (48%) and CS injection (30%). There was no significant difference in recommendations based on geography, seniority or specialisation (i.e., hand surgeons among others). CONCLUSIONS: Neither geography, seniority nor medical specialty affects surgeons' preferences in the treatment of LE. There appears to be little correlation between scientific evidence and therapeutic choices for managing LE. LEVEL OF EVIDENCE: Level V, Study.

Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study.

OBJECTIVE: To report the follow-up of continuing pregnancies after first-trimester exposure to mifepristone. DESIGN: Observational prospective study. SETTING: France. SAMPLE: Patients exposed to mifepristone during the first 12 weeks of pregnancy. METHODS: Women were included in the study when they or their doctors asked a French pharmacovigilance centre or the Paris Teratogen Information Service about the risk of mifepristone exposure in early pregnancy. Exclusion criteria were requests received after 22 weeks of gestation or subsequent elective termination of pregnancy without a pathological examination of the fetus. Data on maternal history and drug exposure were collected on first contact, and pregnancy outcomes were documented at follow-up. MAIN OUTCOME MEASURES: Rate of major congenital malformations. RESULTS: A total of 105 pregnancies were included, with 46 exposed to mifepristone alone, and 59 exposed to both mifepristone and misoprostol. There were 94 live births (90.4%) and 10 (9.6%) miscarriages (including one with major malformation). Elective termination of pregnancy was performed after the subsequent diagnosis of trisomy 21 in one case. The overall rate of major congenital malformations was 4.2% (95% CI 1.2-10.4%), with two cases among 38 patients exposed to mifepristone alone, and two cases among 57 patients exposed to both mifepristone and misoprostol. CONCLUSIONS: This first prospective study found that the rate of major malformations after first-trimester exposure to mifepristone is only slightly higher than the expected 2-3% rate in the general population. Such findings provide reassuring data for risk evaluation for continuation of pregnancy after mifepristone exposure.

[Imaging of male infertility: techniques and results]. / Imagerie de l'hypofertilité masculine : technique et résultats.

Assessment of male infertility includes clinical examination, laboratory tests (semen analysis, hormones dosage) and sonographic examination of the urogenital tract. Male infertility is due to testicular abnormalities (secretory type) or obstructive disorder (excretory type). Imaging should provide accurate definition of anatomical causes of infertility in order to deliver appropriate treatment. Testicular Doppler ultrasound with transrectal ultrasound is the gold standard imaging technique to explore male infertility. MRI, because of its high resolution, provides a multiplanar study especially in congenital and inflammatory abnormalities of the urogenital tract. This pictorial review illustrates the most frequent causes of male infertility.

Ascites characterizes perioperative clinical indices better than preoperative body mass index. A study in orthotopic liver transplant candidates.

BACKGROUND: Preoperative body mass index (pre-BMI) affecting patients' recovery from orthotropic liver transplantation (OLT) is controversial. Pre-BMI measurements may be exaggerated by ascites. Aim of the study was the assessment of early outcome associated with pre-BMI and ascites. METHODS: Postoperative BMI values and ascites volumes of 206 patients undergoing OLT (2006-2007) were reviewed. RESULTS: There were 141 preoperatively "non-obese" patients (pre-BMI ≤ 30 kg/m2) and 65 "obese" patients (pre-BMI >30 kg/m2). Demographics and model for end-stage liver disease scores were similar for both groups. The mean volume of ascites removed from the "non-obese" patients was significantly larger compared to the "obese" ones (P=0.018). Seventeen "obese" patients became "non-obese" postoperatively. The duration of anesthesia, ischemia, surgery, hemodynamic parameters, estimated blood loss and transfused products were similar for both groups. Ascites volumes correlated significantly (P<0.05) with various intraoperative indices but not pre-BMI. At 24 h postoperatively, the extubation rate was better for the "obese" group (99%) versus the "non-obese" group (93%, P=0.03). However, "non-obese" patients were extubated earlier than the "obese" both by 6 h (45% versus 22%, respectively, P<0.01) and by 12 h (88% versus 74%, respectively, P=0.012). The postoperative, but not the preoperative BMI, correlated with extubation rate ≤ 6 h (r=0.924, P=0.0001). No "obese" patients died <1 month postoperatively, compared to 9 "non-obese" patients (P<0.01). Intensive Care Unit and hospital stay were ~25% longer for the "obese" group. CONCLUSION: Pre-OLT BMI does not correlate with ascites or postoperative BMI, nor does it affect duration of ventilation, especially <6 h after surgery. These results dissociate ascites from pre- and post-OLT.

[Autologous fat grafting in radiated tissue prior to breast prosthetic reconstruction: is the technique reliable?]. / La réinjection première de graisse autologue en reconstruction mammaire.

BACKGROUND: Prosthetic breast reconstruction is critical in the radiated breast. The main purpose of this study was to determine whether fat grafting prior to breast reconstruction could improve thoracic tissue trophicity enough to perform a simple prosthetic reconstruction, avoiding a flap procedure. PATIENTS AND METHODS: A total of 25 patients who had undergone a modified radical mastectomy followed by radiotherapy were retrieved. Fat was injected according to Coleman's technique. Prosthetic reconstruction was performed three to six months after the fat grafting procedure. Reconstruction of the nipple-areola complex was performed 3 months after implant positioning. Median follow-up interval was two years. Patient satisfaction was ascertained with a self-assessment questionnaire. Three independent blinded physician observers judged preoperative and postoperative photographs to determine the quality of reconstruction. RESULTS: The mean refined fat injected volume was 160ml. In all cases except two, a unique fat grafting procedure was necessary. Prosthetic reconstruction was achieved in 23 cases. The technique failed in two cases and breast reconstruction was achieved by a latissimus dorsi flap with implant. During the follow-up interval, two complications occurred in two patients presenting with fat necrosis and oil cysts. The mean number of total surgical procedures was 2.5 per patient. Quality of reconstruction was judged as good by both physicians and patients. CONCLUSIONS: Autologous fat grafting in radiated tissue prior to breast reconstruction is a safe and reliable technique. In selected cases, a simple prosthetic reconstruction can be achieved avoiding a flap procedure.

Higher postoperative pain and increased morphine consumption follow pre- rather than post-incisional single dose epidural morphine.

BACKGROUND: Neuraxial administration of morphine is an effective way of controlling postoperative pain and reducing analgesic consumption. Some animal models have demonstrated that preemptive administration of neuraxial narcotics reduces pain, while others have revealed the contrary. In addition, there have been no consistent results in clinical settings. This double-blind, randomized study compared the effects of pre- vs. post-incisional administration of neuraxial morphine on postoperative pain perception and analgesic requirements over 48 hours following laparotomy for open colectomy under standardized general anesthesia. METHODS: Twenty patients received epidural morphine (3 mg) before the incision and saline after wound closure (MO1 group), and twenty patients received epidural saline before the incision and morphine after wound closure (MO2 group). Postoperatively, all patients received morphine boluses (1.5 mg) via intravenous patient-controlled analgesia (IV-PCA) and rescue doses of intramuscular diclofenac (75 mg) every 6 hours, as needed. RESULTS: MO1 patients used significantly (P<0.05) more morphine than the MO2 group during the first 24 postoperative hours and activated the PCA device more frequently throughout the 48-hour study period. The MO1 group was characterized by significantly (P<0.05) higher self-rated pain scores than the MO2 group throughout the study. The self-rated levels of sedation and satisfaction of the MO2 patients were also consistently better (P<0.05) than those of the MO1 patients, especially during the second postoperative day. CONCLUSION: Pre-incisional epidural morphine in patients undergoing open colonic surgery under general anesthesia was associated with more postoperative pain, a greater need for analgesics, and poorer patient satisfaction compared to post-incisional morphine administration.

[Teratozoospermia, myth or reality? A 10-years retrospective study on 101404 consecutive sperm samples]. / Tératozoospermie: mythe ou réalité? Étude d'une cohorte de 101 404 examens de sperme.

OBJECTIVES: Several studies have reported a time-related decline in semen quality. In this context, 101,404 spermograms-spermocytograms performed in a single andrology laboratory from January 2000 to December 2009 were investigated retrospectively. Variations of sperm parameters were analyzed over the years. PATIENTS AND METHODS: For each semen sample, age at semen collection, duration of sexual abstinence, volume of seminal fluid, pH, concentration of spermatozoa, percentages of overall motile and progressive motile sperm, percentage of morphologically abnormal spermatozoa (according to David's classification) and amplitude of lateral head displacement (ALH) were analyzed. For each parameter, the mean value per year was determined. To examine trends over time the statistical tests used were analyses of variance and correlation studies. RESULTS: Data showed an increasing age of patients from 36.5 years in 2000 to 37.2 years in 2009. The semen concentration was 63.5 millions/mL in 2000 and 63.6 millions/mL in 2009 with a slight fall from 2001 to 2008. The vitality continuously increased from 67.8% in 2000 to 73.5% in 2009 as well as the overall motility (from 37.7% to 39.2%) and the progressive motility (from 34.6% to 36.2%). The percentage of morphologically abnormal spermatozoa continuously increased from 64.5% to 84.2% (r=0.43, P<0.001). DISCUSSION AND CONCLUSION: Contrary to a variety of works, our very large study of semen analysis did not show a real decline in semen WHO parameters during a 10-year period, except for the percentage of morphologically abnormal spermatozoa, which dramatically increased over the years.

[Variations in the prevalence of Down's syndrome in the French population between 1978 and 2005]. / Variations de prévalence de la trisomie 21 en population française entre 1978 et 2005.

OBJECTIVES: To evaluate the impact of maternal age and prenatal diagnosis on the prevalence of Down's syndrome at birth in French population sample. PATIENTS AND METHODS: Data concerning Down's syndrome from 1978 to 2005 were obtained from the REMERA registry of congenital malformations. The population surveyed was approximately 10% of French births. We studied total prevalence, live-birth prevalence and the prevalence of pregnancy termination after prenatal diagnosis. RESULTS: Mean maternal age has risen from 26 to 30 years over the study period. Total prevalence of Down's syndrome has increased from 14 per 10,000 in 1978 to 23 per 10,000 live-births in 2005. Termination of pregnancy after prenatal diagnosis of Down's syndrome gradually increased reaching 78% in 2005. Live-birth prevalence decreased from 14 per 10,000 in 1978 to 5.1 per 10,000 in 2005. CONCLUSION: This work shows the importance of continuing the epidemiological survey of Down's syndrome in France, especially because of the modification in population ageing as well in prenatal screening policies for Down's syndrome.

Late recurrent hemarthrosis following knee arthroplasty associated with epithelioid angiosarcoma of bone.

We report a case of recurrent hemarthrosis 1 year following total knee arthroplasty in a patient with no bleeding diathesis, the hemarthrosis was found to be related to, and led to the diagnosis of high grade sarcoma of the proximal tibia. Twenty five years earlier, he sustained a lateral tibial plateau fracture and was treated with open reduction and plating. Sarcoma developing in association with a metallic orthopedic prosthesis or hardware is an uncommon, but well-recognized complication. Sarcomas that occur adjacent to orthopaedic prostheses or hardware are of varied types, but are usually osteosarcoma or malignant fibrous histiocytoma.

Dermatological manifestations of epilepsy among adult Sudanese epileptic patients.

OBJECTIVES: To study the pattern of dermatological changes associated with epilepsy among adult Sudanese epileptic patients. METHODS: This non-interventional descriptive study included 360 adult Sudanese epileptic patients and was conducted at the El Shaab Teaching Hospital, Khartoum, Sudan, from February 2004 to August 2007. All patients had full detailed history and clinical examination. A dermatologist assessed the dermatological changes. Investigations carried out included EEG, CT brain, and serial of drug serum levels. RESULTS: Out of 360 patients, 31 were found to have scars due to repeated attacks of convulsions, one patient was found to have neurofibromatoma, one had tuberous-sclerosis, one had Sturge-Weber syndrome, one had Kaposi sarcoma, one had systemic lupus erythematosus, one diabetic patient had skin atrophy, one patient taking phenobarbitone had skin eruption, one patient on carbamazepine had skin changes, while 5 patients on phenytoin had skin manifestations. CONCLUSION: Skin changes can occur in epileptic patients as part of drug toxicity, or as part of the clinical manifestations of certain diseases that can cause secondary epilepsy, for example, neurofibroma.

[Management of azoospermias]. / Prise en charge des azoospermies.

An oral assessment and thorough clinical examination are an essential prerequisite in the presence of azoospermia (varicocele? absence of vas deferens?). Examination of the volume and pH of the ejaculate must also be included in the assessment, together with measurement of the FSH and testosterone required and a scrotal and prostatic endorectal ultrasound (particularly helpful in the diagnosis of obstructions, testicular nodules etc.). In terms of second-line treatment, the assessment can be completed by prescription of plasma inhibin B, seminal biochemistry and genetic assessment (blood karyotype, diagnosis of microdeletion of the Y chromosome and diagnosis of mutation of the CFTR gene in the case of bilateral absence of the vas deferens). On completion of this assessment, the azoospermia is either obstructive or non-obstructive, even if it is not always this simple. Obstructive azoospermia can be overcome by reconstructive surgery (vasovasostomy, vasoepididymostomy and transurethral resection of the ejaculatory ducts), thus avoiding the need for ICSI. In the case of azoospermia with varicocele, treatment of the varicocele can achieve certain results. Finally, in the case of non-obstructive azoospermia, it is difficult to draw a conclusion between the use of fresh or frozen spermatozoa although many teams favour frozen spermatozoa.

[The interest of early rehabilitation with intracavernous injections following complete prostatectomy]. / Intérêt d'une rééducation précoce par injections intra-caverneuses après prostatectomie totale.

Several factors influence erectile function following radical prostatectomy: cancer and its extension, the technique of nerve sparing, the patient and his relationship with his partner, and the rapidity and mode of post-surgical management. Depending on the surgical technique, this can result in permanent and total erectile dysfunction with severe fibrotic modifications in the absence of nerve sparing, or erectile dysfunction that can be restored by the early management when the nerves have been spared. Treatment within the month following surgery with intracavernous injections of PFE1 improves oxygenation of the cavernous corpus, thus limiting the development of tissue fibrosis, and hence increasing the penile blood flow. In clinical practice, emphasis should be made on the psychological importance of the early return of erections and sexual activity.

[Erectile dysfunction drugs and women]. / Les médicaments de la dysfonction érectile et les femmes.

Erectile dysfunction (ED) is no more a taboo and the number of patients who are consulting a physician and asking for some help in this domain is growing every day. The quality of life of men presenting an ED and having access to treatments is continually improving. But what can be said concerning the partners' quality of life? Patients as much their partners clearly prefer lesser invasive therapeutics and the new oral drugs available present some advantages for the couples, and surely for a majority of female partners, willing to improve the spontaneity and the frequency of intercourse. It seems now obvious that the partner's help is one of the key points for a successful treatment. How will women facing this recovered virility react? What will they say in the secret of the consulting room? What could be exactly the role of the gynaecologist in assuming the female partner of a man treated for an ED? That is the object of the present article, dealing with quite an important matter.