[Etiology of lip defects]. / Etiologies des pertes de substance des lèvres.

Lips repair cannot be considered until the characteristics of the loss of substance which are given by its aetiology, has been carefully determined. Traumatic aetiologies remain dominated by accidents on the public roads associated more often with adjacent damage. Dog bites remain the burden of children and always raise the problem of their septicity. For burns there is a need to wait for the organism to delimit its own viable tissues. Ballistic traumatisms will lead to major damage where functional repair to the lips can often be very difficult. Tumours of the lips, essentially malignant, lead to wide exeresis, where the margins are dictated by histological findings. They, of course, pose the problem of eventual neck node dissection and are dominated by squamous cell carcinomas.

[Delivery of desflurane by a Tec 6 vaporizer at a concentration superior to that posted on the regulating valve]. / Libération par un vaporisateur Tec 6 de desflurane à une concentration supérieure à celle affichée sur le bouton de réglage.

We report the case of a defective Tec 6 vaporizer (Datex-Ohmeda) which delivered higher concentrations of desflurane (end-tidal concentration: 3.5 vol%) than indicated by the vaporizer dial setting (2 vol%), at a fresh gas flow of 1 L.min-1. This condition was caused by a defective rotary control valve. Therefore it is essential to administer desflurane only in presence of a vapour analyser.

[Subadventitial cyst of the popliteal artery. Non-invasive explorations. Anatomo-pathologic data]. / Kyste sous-adventiciel de l'artère poplitée. Explorations non invasives. Données anatomo-pathologiques.

Subadventitial cyst of the popliteal artery is a well known entity. We report a new case and the diagnostic and therapeutic advantages of noninvasive explorations. Transcutaneous duplex-scan provided diagnosis and showed cystic formations in contact with a segmentary occlusion of the popliteal artery. Magnetic resonance imaging (MRI) evidenced communication between the cysts and the articular capsule of the knee joint. Surgical exeresis confirmed the communication with the synovial fluid. This observation demonstrated: i) the contribution of duplex-scan for the diagnosis of adventitial cysts and arterial consequences; ii) the contribution of MRI in identifying communication with the synovial fluid; iii) the presence of arterial wall lesions (necrosis of the media) would favor no conservative treatment.

A possible linkage of HLA-DRB haplotypes with Tiopronin intolerance in rheumatoid arthritis.

To investigate the relationship between HLA class II genotypes and toxic intolerance during treatment with Tiopronin, a slow-acting drug used in the treatment of rheumatoid arthritis (RA), we studied 40 patients who were divided into two groups: a group of 22 patients without side effects and a group of 18 patients with intolerance to Tiopronin. The PCR-RFLP method was used to determine the HLA-DR, DQ and DP genotypes. The patients in the two groups had similar genetic backgrounds with an expected high frequency of DRI and DR4 alleles. However, DR1/DR4 heterozygosity was significantly increased in patients with intolerance (p = 0.03, Odds Ratio = 10.5). In addition, one intolerant patient had a DR1/DR7 genotype which shared DRw53 (DRB4*0101) with DR1/DR4. Furthermore, two subtypes of DR5, DRB1*1102 and DRB1*1201, were increased among intolerant patients (11.1% vs 0%, p = 0.03, OR = 13.97). In total, DR1/DRw53 heterozygotes, DRB1*1102 and DRB1*1201 represented 61.1% of intolerant patients. Therefore, a detailed HLA class II typing might be useful before RA treatment by Tiopronin to predict and avoid toxic side effects in the patients with increased risk. Further investigation is currently underway.