[Value of the use of a vicryl-collagen tape for the treatment of cleft palate. Experimental study in dogs]. / Intérêt de l'utilisation d'un treillis de vicryl collagène dans le traitement des fentes palatines. Travail expérimental chez le chien.

The purpose of this study was to evaluate the bone forming capacity of a Vicryl/collagene tape, placed in a defect of the palatal bone. In order to decrease the rate of bucco-nasal fistulaes after primary closure of a cleft palate, the authors carried out an experiment on dogs. First of all, we had to demonstrate the good tolerance of the tape in the buccal cavity. The first group of 5 dogs redieved the tape between buccal mucosae and palatal bone. The tolerance was excellent concerning the 12 biopsies on the mucosae after 1 month; 10 were totally normal and 2 revealed signs of inflammation on the medial incision. Concerning the second group, we needed to know the delay of bone formation of a "neo-palatal" defect; for that reason a 2 cm2 bone resection and a histological observation after 1 month and 1,5 months, in the right palatal bone was performed. Then we performed the same resection in 5 other dogs, and let the vicryl tape in the defect before closing the mucosae. The histological results of the second group showed that the ossification began after 1 month, and after 1.5 months the defect was totally covered by bone. The good results we obtained led us to go on with this experiment even if the low number of dogs included in this series does not allow us to a statistical evaluation. Exact responsibility of both, vicryl and collagene, has to be determined by a longer experiment, before realising the device in child's cleft palate.

[Closure of residual clefts of the palate. Indications and technic]. / Fermeture des fentes résiduelles du palais. Indications et technique.

Residual defects of the palate, a possible complication of early surgery in the view of MALEK and PSAUME, should be closed as early as possible in order to avoid compromising normal acquisition of language while respecting bony growth. The technique described (staphylorrhaphy under cover of a rigid compression arch) takes both these requirements into account.

[Treatment of labio-palate clefts]. / Traitement des fentes labio-palatines.

The reeducation of the patient afflicted with an unilateral or bilateral complete cleft of the lip and/or palate (CLP) needs many years of treatment. A new approach to the sequence and timing repair is based on a very sound concept of the function of the tongue in new-born which is disturbed in CLP and thus deviates the swallowing. The tongue must be educated early in order to assure its physiological pressure towards the anterior palate during swallowing. Furthermore, this seems to improve the maxillary growth. The first long term follow-ups are now available and suggest that the method is effective.

[Mesenteric neurofibromatosis. Apropos of a case]. / Neurofibromatose mésentérique. A propos d'une observation.

The authors report a case of severe Recklinghausen's disease, revealed early in infancy, by spinal deformities and then by severe dislocations with kypho-scoliosis surgically treated by anterior and posterior fusion. Other localisations of neurofibromatosis were present, especially bones and skin. During the disease's course a wide sub-cutaneous tumor of the chest wall was removed. Two years later a large abdomino-pelvic tumor of the mesentery was discovered and also removed. Histologic examination showed it to be related to Recklinghausen's disease and malignant. The authors analyse the risk of malignant degeneration of this tumor with relation to previous surgical treatment.

[Anterior strut grafting in kyphosis and kyphoscoliosis (author's transl)]. / Greffes antérieures en étai dans le traitement des cyphoses et cyphoscolioses.

The authors have reviewed 58 cases submitted to strut grafting in the concavity of the curve. There were 44 kyphoscolioses and 12 kyphoses. The average follow-up was more than two years and the average pre-operative deformity was 127 degrees. The average improvement was 38 degrees and the secondary loss was only 3 degrees. The results are analysed with regard to the surgical technique used. In some cases, posterior fixation was added and the graft was either from the tibia, the fibula or a rib. In 16 cases a secondary fracture of the graft was found. It appeared between the fourth and tenth post-operative months. During this period, reduction of the graft was seen. The graft was found to thicken later at about the eighteenth post-operative month. It is concluded that the technique is worthwhile provided it is associated with posterior internal fixation, and that an external brace is worn for at least eighteen months after operation.

[Familial case of male pseudohermaphroditism due to 17-ketoreductase defect: late diagnosis in the "aunt" of a patient with the same defect (author's transl)]. / Cas familial de pseudo-hermaphrodisme masculin par déficit en 17 céto-réductase: diagnostic tardif chez la "tante" d'un sujet porteur du même déficit.

A 42 year old (46 XY) subject with 17-ketosteroid reductase deficiency was investigated. The patient reared as female, has developed masculine features (facial hair, male distribution of body hair, male body habitus, acne and clitoridomegaly) at about 15 years of age but never consulted. She married at 22 years and for 20 years thought to have a "normal" female sex life. Only when her 14 year old "niece" was investigated (1) and treated for similar problems she realized hers. She had a small phallus with perineal urethra, vaginal pouch absence of labia minora and undescended testis, no breast development. Baseline peripheral studies showed plasma testosterone (T) in the range of Tanner II stade of puberty (150 ng/dl), elevated delta 4-androstenedione (delta 4) (930 ng/dl) and estrone (E1) (33,5 NG/DL) LEVELS 6--8 times above normal, but subnormal estradiol levels. Increased basal gonadotropins showed an hyper-response to LHRH stimulation. Dynamic tests (ACTH test, Dexamethasone suppression, and hCG stimulation) showed that abnormal delta 4 and E1 were not of adrenal origin. In the spermatic veins delta 4 levels were extremely high (239 micrograms/dl) but T levels low (11.4 micrograms/dl). delta 4/T ratio in the spermatic vein was much higher than in the peripheral blood suggesting intact peripheral conversion of delta 4 to T. After castration all hormone levels returned to the range usually seen in agonadic male or female adults.