Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis.

BACKGROUND: Hidradenitis suppurativa is a very debilitating disease, treated by antibiotics and excision. The reconstruction is usually done by secondary wound healing and/or split-thichness skin graft. The aim of this study was to evaluate the reconstruction of the axilla with local perforator flaps as a single stage surgical treatment. METHODS: This was a monocentric retrospective study conducted between November 2013 and June 2015. We included the patients with a severe axillary localization of the disease. Between 6 months and 1 year postoperatively, we noted length of complete healing, complications, patients satisfaction score about the surgery, DASH functional score, maximum abduction angle of the arm, and recurrence of the disease. RESULTS: Thirteen patients were included, for a total of seventeen affected axillae. We performed seven thoracodorsal artery perforator flaps, seven lateral intercostal artery perforator flaps and three serratus anterior artery perforator flaps. The mean duration of follow-up was 279.1±84.1 days (180-365). The average complete healing time was 20.5±13.5 days (10-60). Six axillae were compounded (35%). The average recurrence rate of HS was 0%. The average score in the DASH questionnaire was 68.6±35.3 points (39-152) and the average maximum abduction angle of the arm was 160.6±18.5 degrees. The average score on the satisfaction questionnaire was 36.5±5.6 points (25-43). CONCLUSION: This is a single stage, reliable and effective surgical procedure. The results are very encouraging, with a good quality of life, a low functional disability and a shorter healing time.

Radiologic analysis of hindfoot alignment: Comparison of Méary, long axial, and hindfoot alignment views.

BACKGROUND: Among radiographic views available for assessing hindfoot alignment, the antero-posterior weight-bearing view with metal cerclage of the hindfoot (Méary view) is the most widely used in France. Internationally, the long axial view (LAV) and hindfoot alignment view (HAV) are used also. The objective of this study was to compare the reliability of these three views. HYPOTHESIS: The Méary view with cerclage of the hindfoot is as reliable as the LAV and HAV for assessing hindfoot alignment. MATERIAL AND METHODS: All three views were obtained in each of 22 prospectively included patients. Intra-observer and inter-observer reliabilities were assessed by having two observers collect the radiographic measurements then computing the intra-class correlation coefficients (ICCs). RESULTS: The intra-observer and inter-observer ICCs were 0.956 and 0.988 with the Méary view, 0.990 and 0.765 with the HAV, and 0.997 and 0.991 with the LAV, respectively. Correlations were far stronger between the LAV and HAV than between each of these and the Méary view. Compared to the LAV and HAV, the Méary view indicated a greater degree of hindfoot valgus. DISCUSSION: Intra-observer reliability was excellent with both the LAV and HAV, whereas inter-observer reliability was better with the LAV. Excellent reliability was also obtained with the Méary view. Combining the Méary view to obtain a radiographic image of the clinical deformity with the LAV to measure the angular deviation of the hindfoot axis may be useful when assessing hindfoot malalignment. A comparison of the three views in a larger population is needed before clinical recommendations can be made. LEVEL OF EVIDENCE: II, prospective study.

Surgical treatment of trans-sphincteric anal fistulas with the Fat GRAFT technique: a minimally invasive procedure.

AIM: Anal fistulas are common pathologies with a significant social impact; however, their treatment is often complex and the recurrence rate can be significant. Some surgical treatments for fistula are also associated with the risk of sphincter injury. In this technical note, we aim to evaluate the feasibility and efficacy of the Fat GRAFT technique (Fat Grafting in Anal Fistula Treatment) in the treatment of recurrent anal fistulas. METHOD: All patients presenting with recurrent trans-sphincteric anal fistulas over an 18-month period were included. After abdominal fat harvesting and fat preparation, fat grafting was performed in the track and peripheral area of the fistula. The internal and external openings of the fistula were closed to maximally preserve the retention of the adipocyte graft in the fistula. RESULTS: Eleven patients underwent the Fat GRAFT procedure (seven men, four women). The average re-injected volume for each fistula was 21 ml (range 10-30 ml). The postoperative course was uneventful. At 6 months three patients developed recurrence (73% healed). There were no postoperative complications. CONCLUSION: The Fat GRAFT technique appears to be a promising technique with a low risk of anal incontinence, in contrast to other techniques. This method was effective in > 70% of patients in a single session.

[Idiopathic bilateral patellar tendon rupture]. / Rupture bilatérale idiopathique du tendon rotulien.

In the absence of systemic disease, specific treatment or sport tendonitis, simultaneous bilateral patellar tendon rupture is rare. Often missed on the first glance, it represents a diagnostic difficulty that should not be overlooked at the initial medical visit. The loss of active extension of the lower limb and a radiographic patella alta, even in a bilateral context, should raise suspicion of this diagnosis. It is then necessary to search for predisposing causes and to evoke the differential, or frequently associated, diagnoses. The present report illustrates these diagnostic difficulties and summarizes some clinical considerations that might help to avoid neglecting these different elements at the first medical visit (positive diagnosis, associated lesions, favouring factors).

[Breast reconstruction for gigantomastia complicating pregnancy. A case report]. / Reconstruction mammaire après gigantomastie gestationnelle: à propos d'un cas exceptionnel.

The authors report a very rare case of gestational gigantomastia and the pregnancy could be carried out in term. The patient has been operated of bilateral mastectomy with immediate reconstruction. Surgery is the only radical treatment. Mastectomy with secondary reconstruction is reserved to cases where the intervention must be fast. Mastectomy with immediate reconstruction is the advised intervention if there is a later desire of pregnancy. Mammary reduction is more aesthetic, and allows only one intervention, but exposes to an important risk of recurrence and is not recommended if there is a later desire of pregnancy.

Observation of a p-wave one-neutron halo configuration in (37)Mg.

Cross sections of 1n-removal reactions from the neutron-rich nucleus (37)Mg on C and Pb targets and the parallel momentum distributions of the (37)Mg residues from the C target have been measured at 240 MeV/nucleon. A combined analysis of these distinct nuclear- and Coulomb-dominated reaction data shows that the (37)Mg ground state has a small 1n separation energy of 0.22(-0.09)(+0.12) MeV and an appreciable p-wave neutron single-particle strength. These results confirm that (37)Mg lies near the edge of the "island of inversion" and has a sizable p-wave neutron halo component, the heaviest such system identified to date.

Damage control orthopaedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers.

INTRODUCTION: The purpose of this study was to analyze the use of temporary external fixation within the perspective of a damage control orthopedics attitude in the management of battlefield extremity injuries. HYPOTHESIS: Damage control orthopaedics (DCO) is a valuable treatment option for easy and rapid limb fracture stabilization in an unfavorable surgical environment. METHODS: Sixteen French soldiers wounded on the battlefield between 2004 and 2009 and managed by damage control orthopedics were included in this retrospective series. All patients were males with a mean age of 30 years (20-53 years). Eighteen external fixators were applied on the theater of operations for multiple injuries (five cases), closed fractures of the pelvis or long bones (three cases) and open osteoarticular lesions (ten cases). RESULTS: After medical evacuation from original theater, conversion to internal fixation was possible in five cases. External fixation was maintained in thirteen cases due to the severity of the lesions or infectious complications. Bone union was achieved in all cases. The mean time for bone union was 2.8 months (2 to 3 months) in case of conversion to internal fixation, and 6.3 months (1.5 to 17 months) when external fixation was extended. To achieve bone union, three devices were removed after a three or four month period and converted to rigid internal fixation associated with bone grafting. No case of septic complication was observed after early conversion. The only case of post-conversion infection occurred after three months of external fixation. After a mean follow-up of 19 months (6 to 49 months) all patients recovered functional autonomy and thirteen could return to duty. CONCLUSION: When possible, early conversion from external to internal fixation improves bone union and functional recovery after war limb injuries in properly selected patients.

[Comparative study of the anatomic and clinical effect of Weaver or subtotal subscapularis tendon section in Latarjet procedure]. / Etude comparative de deux techniques de section du tendon du muscle subscapulaire dans l'opération de Latarjet.

PURPOSE OF THE STUDY: The aim of this work was to compare the anatomic and functional effect on the subscapularis muscle of two ways of sectioning its tendon during Latarjet procedure: complete vertical section and Weaver section (partial section of the lower third preserving the upper part of the tendon). MATERIAL AND METHODS: We compared two series (eight-year interval) of patients comparable for age, gender, form of instability, type and level of sports activity. Twenty-nine patients underwent complete vertical section (group 1) and 30 Weaver section (group 2). All were reviewed with minimum four year follow-up. The clinical analysis involved strength of internal rotation, the maximal hand-back distance, and the Constant and Duplay scores. The radiographic analysis was coupled with computed tomography in 46 patients (23 in each group). Loss of subscapularis muscle thickness compared with the non-operated side was noted as was the Bernageau fatty infiltration stage. RESULTS: No recurrent dislocation was noted in either group. There were six cases of nonynion in group 1 and seven in group 2. The Gerber was positive in five patients in group 1 and zero in group 2 (P=0.01). Loss of internal rotation strength between the operated and healthy side, expressed in percentage, was 48.4% for group 1 and 17.9% for group 2 (P<0.0006). In group 1, the fatty infiltration stage of the subscapularis muscle was: stage 0 (n=3), stage 1 (n=11), stage 2 (n=3), stages 3 and 4 (n=6). In group 2, these stages were: stage 0 (n=21), stage 1 (n=1), stage 1 (n=2) and zero stage 3 and 4 (P<0.0001). DISCUSSION: The Latarjet operation remains the reference procedure for anterior stabilization of the shoulder joint. The choice of the incision technique for the subscapularis muscle tendon remains a subject of debate. Recent studies have demonstrated the importance of subscapularis muscle trophicity to obtain a good mid- and long-term clinical outcome. We have ourselves demonstrated elsewhere that complete section of the subscapularis tendon leads to secondary tears and subsequent fatty degeneration. CONCLUSION: Our study demonstrates that Weaver section in the Latarjet procedure enables placing the bone block in conditions equivalent to those achieved with total section while preserving better trophicity of the subscapularis muscle.

Selective expression of two types of 28S rRNA paralogous genes in the chaetognath Spadella cephaloptera.

Significant intra-individual variation in the sequences of the ribosomal RNA (rRNA) genes is highly unusual in animal genomes; however, two classes of both 18S and 28S rRNA gene sequences have been detected in chaetognaths, a small phylum of marine invertebrates. One species, Spadella cephaloptera Busch, 1851, is well-suited to the methods of in situ analysis of gene expression, since it is totally transparent. To test our hypothesis of a possible functional division of the two classes of genes, we carried out in situ hybridization. Our results indicated that 28S class II genes are expressed intensively in the oocytes of chaetognaths. In contrast, hybridization using an heterologous probe of 28S class I genes revealed only a single and relatively weak signal in a distinct area of intestinal cells. Our results suggest that the S. cephaloptera genome contains at least three different types of rRNA 28S genes; however, those which are expressed during housekeeping conditions could not be detected in our experiments.

[Pseudoaneurysm of the deep palmar arch due to infective endocarditis]. / Faux anévrisme de l'arcade palmaire profonde et endocardite infectieuse.

The authors report a case of mycotic pseudoaneurysm of the deep palmar arch in a complicated case of Staphylococcus aureus infective endocarditis. They review the literature to discuss the physiopathology, diagnosis and treatment of this rare complication.

[Isolated lesion of the infraspinatus at the myotendinous junction: a new lesion]. / Lésion isolée de l'infra-épineux à la jonction myotendineuse: une nouvelle lésion.

PURPOSE: We have identified a previously unpublished lesion of the infraspinatus muscle at the myotendinous junction. We describe its presentation and MRI appearance, notably the absence of other tendinous pathology in the rotator cuff. MATERIALS AND METHODS: We retrospectively reviewed 25 patients with isolated infraspinatus lesions and associated edema identified on the fat-suppressed T2-weighted images of MRI. Imaging exams and medical records collected over a 7-year period were reviewed by a team of radiologists and surgeons specializing in the shoulder. A presentation of the mechanism of injury, radiological analysis of MRI scans and other investigations (arthro-CT and EMG studies) were carried out; all MRI included at least two fat-suppressed T2-weighted (transverse and coronal) sequences and one T1-weighted (transverse) sequence. RESULTS: The lesion was characterized by tearing or delamination at the myotendinous junction, which was accompanied by edema of the infraspinatus muscle in the initial phase. Over time the edema was seen to resolve and muscle atrophy and fatty degeneration became predominant. We identified two groups by the onset of their symptoms. In the "chronic" group (44%), onset was gradual, with these patients frequently having had one or more infiltrations at presentation to us. In the "acute" group (56%), there was an initial traumatic event that was variable in intensity and mechanism. CONCLUSION: This isolated lesion of the infraspinatus at the myotendinous junction has not been previously described. It is recognized by its characteristic MRI appearance and is not generally seen on CT arthrograms as there is no communication with the joint. Its natural history appears to be of a progression from edema to fatty degeneration with or without myotendinous retraction and scarring. Its etiology has not yet been clearly established.

[A serious complication of sternal puncture: penetrating injury of the ascending thoracic aorta]. / Une complication grave de la ponction sternale: la plaie de l'aorte thoracique ascendante.

INTRODUCTION: Penetrating thoracic aorta wounds are rare but responsible for a high mortality when medical and surgical management is delayed. OBSERVATION: We report the case of a 71 year-old patient with malignant lymphoma who sustained an accidental penetrating injury of the ascending thoracic aorta while undergoing trephine biopsy of the sternum. He was successfully treated with emergency sternotomy and aortic suture-repair. CONCLUSION: This case report highlights the limits of sternal trephine biopsy, notably in patients whose bones are weakened by a malignant haematological process, and proposes preventive measures in order to avoid accidents.

Laparoscopic treatment of pancreatic pseudocysts.

BACKGROUND: A multicentric study was performed to evaluate the clinical results after laparoscopic treatment of pancreatic pseudocysts (PP). METHODS: We collected the data of 17 patients presenting with PP and operated on by laparoscopy between 1996 and 2001. There were nine men and eight women with a median age of 42 years (range 30-72). In 15 patients the PP developed after acute pancreatitis and the median delay between the acute onset and surgery was 7 months (range: 2-24). In two patients the PP was associated with chronic pancreatitis. All the patients had a single PP with a median diameter of 9 cm (range: 5-20). RESULTS: According to the location of the PP, a cystogastrostomy was performed in 10 patients and a cystojejunostomy in seven patients. The median operative time was 100 min (range: 80-300). Laparoscopic PP surgery was completed successfully in 16 patients and the median size of the cystoenterostomy was 3 cm (range: 2-5). Necrotic debris was present within the PP in 11 patients. The median postoperative hospital stay was 6 days (range: 4-24). No mortality and no immediate morbidity were recorded. However, two patients were readmitted within the first 3 postoperative weeks because of secondary PP infection. The first patient had an early closure of cystogastrostomy and was treated by endoscopic placement of a stent. The second represented with a right retrocolic abscess after cystojejunostomy and was treated by percutaneous drainage. One patient was lost for follow-up 2 months after surgery. The others had regular clinical and radiological controls. With a median follow-up of 12 months (range: 6-36), no recurrence of PP was observed. CONCLUSIONS: The laparoscopic treatment of PP was associated with a low postoperative complication rate and an effective permanent result. That approach avoided some difficulties, particularly bleeding that is classically linked with endoscopic internal drainage.

Evidence for the presence of serotonin in Mysidacea (Crustacea, Peracarida) as revealed by fluorescence immunohistochemistry.

In crustaceans, serotonin (5-HT) exerts a wide range of physiological actions on many tissues. However, 5-HT has not been detected to date in Mysidacea (Crustacea, Peracarida). We have investigated the presence of 5-HT in the brain and the eyestalks of two Mysida (Leptomysis lingvura, Hemimysis margalefi) and one Lophogastrida (Lophogaster typicus) species by using the immunohistofluorescence technique. 5-HT-like immunopositive areas exhibit a similar pattern in the three species. 5-HT-like immunostaining is present in the retinular photosensitive cells, except in the deep-living species L. typicus. 5-HT-like cell bodies and fibres are observed in the lamina ganglionaris and in the three medullae. In the sinus gland, only 5-HT-like endings are detected. In the eyestalks, 5-HT-like fibres detected in the optic tract link with the protocerebrum, in which 5-HT-like somata and their extensions are found. Some neurones are detected in the anterior median cell cluster, in the protocerebral bridge and in the central body. In the deutocerebrum, the paracentral lobes are connected by immunoreactive fibres that run along the deutocerebral commissure. The glomeruli of the olfactory lobes exhibit strong diffuse immunostaining. Beside and in the median part of the deutocerebrum, at least two large serotoninergic neurones project their axons into the olfactory lobe cell cluster. Immunoreactive fibres are also found in the antennular neuropiles. Our results demonstrate the presence of 5-HT-like cell bodies and fibres in Mysidacea. The distribution patterns of the 5-HT immunoreactivity found herein are compared with those of other peracarids and decapods.

[Absorbed dose during helical acquisition CT. Effect of acquisition parameters]. / Dose délivrée lors d'un examen scanner en acquisition hélicoïdale. Influence des paramètres d'acquisition.

PURPOSE: European directive 97/43 specifies that the dose delivered to the patient during a radiological procedure should be estimated. In order to prepare for implementation of this new regulation, we have studied the dose delivered during spiral CT acquisition. MATERIALS AND METHODS: We have studied the influence of slice thickness, pitch, tube voltage and intensity, and acquisition volume length. We present measurements for single and dual detector CT scanners. We used a pencil ionization chamber to measure air kerma. We measured absorbed dose in water with a waterproof ionization chamber set in a semi-customized phantom filled with water. Chambers were set on the rotation axis of the CT scanners. We studied the dose outside the acquisition volume. RESULTS: We quantified the influence of each parameter on the absorbed dose. We used our measurements to calculate the dose for different acquisition protocols. Also we evaluated the dose to organs distant from the acquisition area. CONCLUSION: This study is one step toward a systematic estimation of the dose delivered to patient during helical CT exams. To use these results in daily practice, we have to develop software using our measurements.

[The Bimler method in the treatment of sagittal shift of the skeletal base in Class II division 1 malocclusion]. / Méthode de Bimler dans le traitement du décalage sagittal des bases osseuses des classes II, 1.

Inadequate sagittal development of the mandible (class II, division 1 malocclusion), is one of the most frequent in dentofacial malformations. We present the Bimler "gebissformer", removable and functional appliance and its tridimensional action. The treatment can be started during the deciduous dentition or in mixed dentition. Therapeutic results, increase of SNB angle, maxillary expansion, and reduction of the deep bite are presented. While therapeutic failure is observed in 30% of the cases (by absence of tissular response or poor patient compliance), the stability of the results in 70% of the remaining cases and its total inocuity make this appliance an interesting method of treatment.

Closed loop control of PaCO2 during ECC.

A prototype for the control of blood gases during extracorporeal circulation (ECC) has been built. It is composed of a CDI300 continuous gas blood analyzer, a programmable gas blender and an IBM PC. The air blender is composed of three mass flow controllers (air, oxygen and total flow rate). The microcomputer commands these controllers in order to obtain the desired mixture of air and oxygen. The system acquires the data sent by the blood gas analyzer every 6 seconds and commands the gas blender in order to maintain the desired arterial dioxide partial pressure (PaCO2) in the arterial line. The first experimental results on sheep show that if blood gas parameters are stable when beginning the closed loop control, then the desired PaCO2 value may be obtained. Otherwise, the value of PaCO2 under control is slightly different but a stable value is obtained after 10 minutes. More experiments must be done in order to establish the real limits of such a system and optimize the gain of the control system.

In vitro evaluation of vena cava filters.

PURPOSE: The authors tested in vitro nine caval filters to evaluate clot-trapping capacity and transfilter pressure gradients under varying experimental conditions. MATERIAL AND METHODS: The filtering efficiency of the stainless-steel Greenfield filter was evaluated in a modified flow model. A total of 2,100 clots were injected. In addition, controlled parameters simulating in vivo conditions were selected to appreciate clot-trapping capacity and pressure gradients for nine filters in horizontal and vertical positions, by using small (3 x 30 mm) and medium-sized (5 x 30 mm) clots. Statistical evaluation was performed for 3,600 clot deliveries. RESULTS: Depending on experimental conditions, the clot-trapping capacity of the Greenfield filter varied greatly (0%-78%) by using small and medium clots. Bird's Nest and Simon nitinol filters demonstrated the highest filtering efficiency (94%-100%) for small clots. Medium clots were effectively captured by Bird's Nest, Simon nitinol, Antheor, and Günther Tulip filters (79%-100%). CONCLUSION: Experimental parameters influence a filter's clot-trapping capacity. Bird's Nest filters demonstrated the highest clot-trapping capacity.

Evaluation of a cardiopulmonary preservation method for heart-lung transplantation.

This study was designed to examine whether concomitant administration of anti-free radicals with donorcore cooling on cardiopulmonary bypass (CPB) and hypothermic storage of the heart and lung, could provide successful extended cardiopulmonary preservation. Fourteen sheep heart-lung blocks harvested after core-cooling and cardioplegic arrest were preserved at 4 degrees C for 8.5 hr. Before and during CPB, the animals were perfused with Prostaglandin E1 (PGE1), superoxide dismutase (SOD), catalase (CAT) and deferoxamine (DEF). Cardioplegic arrest was induced with St. Thomas' Hospital solution (Plegisol) to which SOD, CAT and DEF had been added. The preservation solution consisted of Plegisol modified by the addition of K-lactobionate, raffinose, mannitol, SOD, CAT, DEF, a phosphate buffer and penicillin. Histological examination performed on 3 donor heart-lung blocks before and after CPB and cardioplegia, then immediately following cold storage, produced no clear evidence of structural damage in cardiac myocytes and lung parenchyma. Eleven donor organs were therefore transplanted in size-matched recipients with a total mean ischemic time of 12 hr. The combined administration of SOD, CAT, DEF, insulin and glucose during the initial period of reperfusion had no beneficial effect on cardiopulmonary performance. A progressive fall in Pa O2 and mean aortic pressure was observed post-operatively in the 7 animals that were weaned from CPB. Five of them died within 3 to 5 hr after CPB weaning, the remaining 2 animals died of cardiac arrest within the fourth hour. The results of this experiment seem to indicate that: 1. better organ function and improved survival could have been obtained if the duration of anti-radical treatment had been prolonged after reperfusion and, 2. physical manipulation of the donor grafts during harvesting and transplantation may have been partly responsible for the poor post-transplantation cardiopulmonary performance.

Heparin removal in three intraoperative blood savers in cardiac surgery.

The aim of the study was to compare the residual heparin in the composition of autologous blood retransfusion units harvested during cardiac surgery under extra-corporeal circulation with three different intraoperative autologous blood savers. In this institutionally approved study, thirty patients undergoing CABG were randomly assigned to three groups according to the intraoperative blood saver used during the procedure: {HAEMONETICS Cell Saver IV (n=10)--DIDECO/SHILEY STAT (n=11)--BRAT 250 (n=9)}. Anaesthesia and conduct of bypass were identical for all patients. The initial heparin dose was 300IU-kg -1 and was supplemented to maintain an activated coagulation time over 480s. The harvested blood was processed according to the procedure defined by each equipment manufacturer. The biological study was performed on the first blood sediments sampled before administering protamine to the patient. Blood cell count, residual heparinemia assessed by its anti-Xa activity using an amidolytic method {STACHROM HEPARIN--DIAGNOSTICA STAGO}, and weight of the blood sediment proteins were determined. Demographic data did not differ between groups. Despite a slight but significant difference between groups, the three devices provided virtual elimination of heparin. The total protein content was significantly higher in the BRAT 250 group. There was a highly significant positive correlation between the anti-Xa activity and total protein content. Haematologic data were within clinically acceptable ranges.