[Massive sinus-lift procedures with beta-tricalcium phosphate: long-term results]. / Greffes sinusiennes massives par phosphate tricalcique. Résultats à long terme.

INTRODUCTION: The use of bone substitutes in massive sinus-lift pre-implant procedures remains controversial. The aim of our study was to evaluate the long-term reliability of pure-phase beta-tricalcium phosphate (betaTCP, Cerasorb, Curasan, Kleinostheim, Germany) used in this particular indication. MATERIAL AND METHOD: Twenty patients (33sinus) presenting with severe sinus floor atrophy (class 4 to 6 according to Cawood) and having undergone a sinus lift procedure by mean of betaTCP were followed in a prospective study between January 2002 and May 2008. The surgical approach was classical (under local anesthesia in eight patients) and the sinuses were filled with betaTCP (6 cm3 on average per sinus) and autologous growth factors (platelet rich plasma PRP and platelet rich fibrin PRF, according to the technique described by Dohan and Weibrich). One hundred and twenty-three dental implants were inserted in the grafted sinuses between the fourth and the eighth postoperative month (Nobel Biocare MK III and MK IV-mean length: 12.44 mm) using a 2-step buried technique and loaded between the fourth and the sixth month. Follow-up included regular clinical examination and panoramic X-rays to screen for possible sinus and implant complications. The control X-rays also allowed measuring the biomaterial resorption rate. RESULTS: The mean postoperative follow-up was 4.5 years for the sinus lift procedures and 4 years for the implants. We noted one case of local infection at the 15th postoperative day (3%). The implant success rate was 97.6% (lack of osteo-integration for two implants in the same patient, one failure after loading). The prosthetic success rate was 100%. The mean resorption rate of the material was 20.3% and the mean gain of height was 16.9 mm. DISCUSSION: The use of betaTCP associated to growth factors (PRP ou PRF) without bone graft, in massive sinus-lift procedures induces few complications. The implant success rate is comparable to the one obtained by using autologous bone grafts. The resorption rate of the material is comparable to that of autologous bone.

[Intra-abdominal desmoplastic small round-cell tumors. An entity among peritoneal carcinomatoses in young adults]. / Tumeurs desmoplastiques intra-abdominales à petites cellules rondes. Une entité parmi les carcinoses péritonéales de l'adulte jeune.

Desmoplastic small round-cell tumors in young adults were first described in 1989. They may be revealed by an abdominal mass or a peritoneal carcinomatosis. The diagnosis and the initial treatment are based on debulking surgery. Chemotherapy using doxorubicin, ifosfamide, etoposide and cisplatin can then be proposed. Despite some initial chemosensitivity, prognosis remains poor.

[Cytomegalovirus infections in patients after liver transplantation: determination of risk groups]. / Infections à cytomégalovirus chez les transplantés hépatiques: détermination de groupes à risque.

The goal of this study was to identify high-risk groups for cytomegalovirus infection after liver transplantation. Sixty-one patients were evaluated. Twenty-five patients (41 percent) had infection. Among the 16 patients who were seronegative for the virus before transplantation, 11 received a liver graft and blood products from seronegative donors and none of them developed infection. All seronegative recipients of a liver from seropositive donors (5/5) developed primary infection. Among the 45 patients seropositive before transplantation, 20 developed a cytomegalovirus infection, whatever the donor serologic status. The incidence of symptomatic reactivation or reinfection was high (14/20), and, for 12/14 of them, associated with early acute rejection. Two high-risk groups of patients, eligible for cytomegalovirus prophylaxis, were identified: seronegative recipients of seropositive donors and seropositive recipients with early acute rejection.

[Liver transplantation in adults: postoperative management and development during the first months]. / Transplantation hépatique chez l'adulte: prise en charge postopératoire et évolution au cours des premiers mois.

Recent improvements in the results of orthotopic liver transplantation (OLT) have made this a well-accepted treatment for patients with severe hepatic failure. Current problems encountered following OLT are discussed. Immediate complications comprise surgical bleeding, primary graft non-function, and graft failure due to hepatic artery occlusion. Secondary complications are frequent. Surgical ones include biliary and vascular (hepatic artery thrombosis most often) problems, as well as intra-abdominal abscesses associated with gastrointestinal perforation, biliary leak, graft ischaemia or an infected haematoma. 40% of patients having undergone OLT will be reoperated on, 2/3 of them within 3 months. Non-surgical complications are mostly pulmonary. The risk of pneumonitis is increased by prolonged mechanical ventilation; it is always potentially disastrous in the immunosuppressed, transplanted patient. Hypertension is also often seen in the early postoperative period; it requires prompt treatment. Early renal impairment after OLT is common, and of better prognosis than late onset renal failure, which is generally associated with shock, graft failure, sepsis or use of nephrotoxic agents. Seizures, usually only one, occur in about 10% of patients; recovery is complete. Encephalopathy with intracranial oedema related to fulminant hepatitis has a worse prognosis, but survival figures are quite encouraging. Three type of rejection are described after OLT: 1) severe accelerated rejection (very rare), 2) acute rejection encountered in about 70% of patients over the first 3 months, and 3) late rejection, which can lead to the vanishing bile duct syndrome (VBDS). Diagnosis of rejection is made by liver biopsy. Prophylactic immunosuppression includes cyclosporin, methylprednisolone and azathioprine. Cyclosporin toxicity and drug interactions are reviewed. Treatment of acute rejection episodes comprises an initial bolus of high doses of corticoid drugs; if there is no response, antilymphocyte globulin or monoclonal antibodies may have to be used. Infection is the main cause of death following OLT. Early infections, mostly intra-abdominal and pulmonary, are bacterial or fungal. Vital (especially CMV) and other opportunistic infections occur generally after the second week. Retransplantation, carried out in 10 to 25% of patients, may be urgent in case of primary graft failure, or hepatic artery thrombosis associated with graft failure, or hepatic artery thrombosis associated with graft failure. Other indications are early graft rejection with severe hepatic dysfunction, chronic rejection with severe VBDS, and recurrence of the initial disease.

[Endolymphatic curietherapy by lymphography with labelled lipiodol in Hodgkin's disease. A report on 408 cases (author's transl)]. / La curiethérapie endolymphatique par lymphographie au lipiodol marqué dans la maladie de Hodgkin. 408 observations.

The results of 373 lymphography examinations with radioactive lipiodol, conducted in 408 patients with Hodgkin's disease for diagnostic and prophylactic therapeutic purposes, during investigations carried out from 1966 to 1973 are analyzed. Tolerance was always excellent, especially from the hematological point of view. The efficacy of the procedure can be assessed by the fact that there were only 6% of failures (21/373) in glandular regions irradiated in this way for prophylactic purposes. Relapses occur more frequently in the inguino-iliac and lumbo-aortic regions than in the pelvic chains which were perfectly protected. This technique also enables both pelvic irradiation and ovarian protection in young women without any risk of failure. The procedure is particularly indicated in the following cases: supradiaphragmatic stages I and II, whatever the sex, and stage III especially in women. In sub-diaphragmatic stages I and II, it allows, in favourable cases, the ovarian function in women to remain intact by limiting external irradiation to invaded regions only.