GUEPAR hinge knee prosthesis.

Early and late results of the GUEPAR hinge knee prosthesis were evaluated on a series of 184 operations performed before January 1st, 1974. There were 3 immediate deaths and 26 before 5 years. Nineteen prostheses were removed. One hundred and twenty-six knees had degenerative osteoarthritis, 52 rheumatoid arthritis. Twenty-two had been operated on before. Patellar displacement, present in 27% of the cases, was the most frequent cause of complaint: pain or instability, proportional to the severity of displacement, made re-operation necessary in 10% of the patients. Addition of a patellar prosthesis was the most successful treatment as far as pain is concerned: it is probably advisable as a primary procedure. Deep infections occurred in 8.3% of the cases, infrequently after 2 years. Healing was obtained in all cases either by revision or by removal and arthrodesis: but functional results were poor except when fusion was achieved, in half of the cases of arthrodesis. Loosening occurred in 16% of the cases, mainly as a consequence of inadequate technique. It was frequently tolerated: re-operation was necessary in 6% of the total. Late functional results were evaluated in 99 cases with a follow-up of 5 to 8 years. Apart from loosening, the results did not deteriorate. Sixty percent were evaluated as excellent or good, 29% fair, and 11% poor. In consideration of these results, the choice of this prosthesis should be limited to special cases. To prevent complications, the use of a patellar prosthesis, of reinforced models and of cementing under pressure is advisable.

Stereoselective synthesis of iso-dolaproine via dynamic kinetic resolution.

[see reaction]. An efficient multigram-scale synthesis of optically pure Boc-(2S,3R,4S)-iso-dolaproine is reported using dynamic kinetic resolution (DKR). The catalytic asymmetric hydrogenation of ethyl (4S)-3-(2'-pyrrolidinyl)-3-oxo-2-methyl propanoate hydrochloride using in situ generated Ru[(S)-MeO-BIPHEP]Br2 catalyst affords the anti beta-hydroxy alpha-methyl ester quantitatively. The two new stereogenic centers are simultaneously controlled with high diastereoselectivity.

Efficient metallo-ene reactions in organoaqueous phase.

[reaction: see text] The easily prepared catalyst systems PdCl(2), RhCl(2)(COD)(2), NiCl(2).6H(2)O, or Ni(COD)(2)/TPPTS have been found to form a C-C bond in organoaqueous medium. Intramolecular metallo-ene reactions have been efficiently realized. Metal selectivity has been discovered.

Asymmetric synthesis of hydroxylated pyrrolizidine, indolizidine, and (+)-alpha-conhydrine via ruthenium-catalyzed hydrogenation.

The enantioselective ruthenium promoted hydrogenation of beta-keto ester, derived from (S)- or (R)-proline and (S)-pipecolic acid, provided a new efficient route to hydroxylated pyrrolizidine or indolizidine ring systems in diastereomeric excesses up to 99%. A practical synthesis of (+)-alpha-conhydrine is also reported.

[Urodynamic exploration in functional micturition disorders in children]. / Exploration urodynamique des troubles mictionnels fonctionnels de l'enfant.

Urodynamic investigation in paediatric patients is presented. The practical aspects and usefulness of each method are discussed in the cases of functional micturition disorders based upon the most significant results from the literature and the author's experience. Urodynamic investigation in children provides a pathophysiological explanation of bladder-sphincter dysfunction and guidelines for appropriate treatment.

[GUEPAR hinge knee prosthesis (author's transl)]. / Prothèse totale à charnière du genou GUEPAR. Expérience avec cinq ans de recul.

Early and late results of Guepar hinge knee prosthesis have been evaluated on a serie of 184 operations performed before January 1st 1974. There were 3 immediate deaths and 26 before 5 years. 19 prosthesis were removed. 126 knees had degenerative osteoarthritis, 52 rheumatoid arthritis. 22 had been operated on before. Patellar displacement, present in 27 p. 100 of the cases was the most frequent cause of complaint: pain or instability, proportional to the severity of displacement made reoperation necessary in 10 p. 100 of the patients. Addition of a patellar prosthesis was the most successful treatment as far as pain is concerned: it is probably advisable as a primary procedure. Deep infections occurred in 8,3 p. 100 of the cases, unfrequently after 2 years. Healing was obtained in all cases either by revision or by removal and arthrodesis: but functional results were poor except when fusion was achieved, in half of the cases of arthrodesis. Loosening occurred in 16 p 100 of the cases mainly as the consequence of insufficient technique. It was frequently tolerated: reoperation was necessary in 6 p. 100 of the total. Late functional results were evaluated in 99 cases with a follow-up of 5 to 8 years. Apart from loosening, the results did not deteriorate. 60 p. 100 are evaluated as excellent or good, 29 p. 100 fair, and 11 p. 100 bad. With due consideration of these results election of this prosthesis should be limited to special cases. To prevent complications, the use of a patellar prosthesis, of reinforced models, and of cementing under pressure is advisable.

Current status of a hinge prosthesis (GUEPAR).

Although a great many GUEPAR hinge knee prostheses have been successful, the early complications have been numerous. Also, long-term follow up studies have been hampered owing to the patients' advanced age. Many of the patients died of causes unrelated to their knee. The use of this prosthesis is limited to very old patients or individuals with grossly dislocated knees. Previous problems such as patellar pain have been resolved. Because the femoral and tibial stems have been reinforced, they are much stronger and cement is no longer necessary for fixation. The part that articulates with the patella has been changed so that it is now more shallow and better adapted to the shape of the patella.