Improved diagnostic accuracy of readout-segmented echo-planar imaging for peripheral zone clinically significant prostate cancer: a retrospective 3T MRI study.

This study compares the readout-segmented echo-planar imaging (rsEPI) from the conventional single-shot EPI (ssEPI) diffusion-weighted imaging (DWI) for the discrimination of patients with clinically significant prostate cancer (csPCa) within the peripheral zone (PZ) using apparent diffusion coefficient (ADC) maps and pathology report from magnetic resonance imaging (MRI)-targeted biopsy. We queried a retrospective monocentric database of patients with targeted biopsy. csPCa patients were defined as an International Society of Urological Pathology grade group ≥ 2. Group-level analyses and diagnostic accuracy of mean ADC values (ADCmean) within the tumor volume were assessed from Kruskal-Wallis tests and receiving operating characteristic curves, respectively. Areas under the curve (AUC) and optimal cut-off values were calculated. 159 patients (105 rsEPI, 54 ssEPI; mean age ± standard deviation: 65 ± 8 years) with 3T DWI, PZ lesions and targeted biopsy were selected. Both DWI sequences showed significantly lower ADCmean values for patients with csPCa. The rsEPI sequence better discriminates patients with csPCa (AUCrsEPI = 0.84, AUCssEPI = 0.68, p < 0.05) with an optimal cut-off value of 1232 µm2/s associated with a sensitivity-specificity of 97%-63%. Our study showed that the rsEPI DWI sequence enhances the discrimination of patients with csPCa.

Magnetic Resonance Imaging-Targeted Biopsy and Pretherapeutic Prostate Cancer Risk Assessment: a Systematic Review: Biopsie ciblée par Imagerie par résonance magnétique et évaluation pré-thérapeutique du risque de cancer de la prostate : revue systématique.

INTRODUCTION: Multiparametric magnetic resonance imaging (MRI) has been included in prostate cancer (PCa) diagnostic pathway and may improve disease characterization. The aim of this systematic review is to assess the added value of MRI-targeted biopsy (TB) in pre-therapeutic risk assessment models over existing tools based on systematic biopsy (SB) for localized PCa. EVIDENCE ACQUISITION: A systematic search was conducted using Pubmed (Medline), Scopus and ScienceDirect databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We included studies through October 2021 reporting on TB in pretherapeutic risk assessment models. EVIDENCE SYNTHESIS: We identified 24 eligible studies including 24'237 patients for the systematic review. All included studies were retrospective and conducted in patients undergoing radical prostatectomy. Nine studies reported on the risk of extraprostatic extension, seven on the risk of lymph node invasion, three on the risk of biochemical recurrence and nine on the improvement of PCa risk stratification. Overall, the combination of TB with imaging, clinical and biochemical parameters outperformed current pretherapeutic risk assessment models. External validation studies are lacking for certain endpoints and the absence of standardization among TB protocols, including number of TB cores and fusion systems, may limit the generalizability of the results. CONCLUSION: TB should be incorporated in pretherapeutic risk assessment models to improve clinical decision making. Further high-quality studies are required to determine models' generalizability while there is an urgent need to reach consensus on a standardized TB protocol. Long-term outcomes after treatment are also awaited to confirm the superiority of such models over classical risk classifications only based on SB. © 2022 Elsevier Masson SAS. All rights reserved.

Recurrent invasive thymoma with pleural dissemination : disease management and treatment possibilities.

Thymoma is the most common benign neoplasm of the anterior mediastinum presenting often an agressive behaviour typical for the malignants tumors. The rate of invasive thymoma recurrency is relatively high. We present the case of a 55-year old man with a recurrent invasive thymoma with a pleural dissemination, detected on CT-imaging 2 years following his primary surgery. Since the first pre-operative imaging studies showed no invasion of the adjacent organs and a thymoma was suspected, a surgical resection was decided as a first line treatment. Per-operatively a number of adjacent structures were invaded and despite a macroscopical RO resection, the margins were microscopically positive. An invasive thymoma, WHO classification B3, Masaoka stage IVb was diagnosed and the patient received adjuvant radiotherapy. We highlight the role of multimodality treatement and disscus the potential of surgical, radiotherapeutical and systemic therapy in stage IV thymoma as well as in recurrent disease.

Arthroscopic repair of subscapularis tears: preliminary data from a prospective multicentre study.

BACKGROUND: Until the introduction of arthroscopic-assisted surgery for rotator cuff repair, the frequency of subscapularis tears was underestimated. These tears remain challenging to treat even with arthroscopy. The absence of a specific classification system has hampered communication about the treatment and outcomes of the various types of subscapularis tears. The objective of this prospective multicentre study was to validate the relevance of arthroscopic subscapularis tendon repair based on an assessment of short-term outcomes according to the initial extent of the anatomic lesions. METHODS: A prospective multicentre study sponsored by the French Society for Arthroscopy was conducted from March 2010 to January 2011 in 208 patients with subscapularis lesions that were either isolated or associated with limited anterosuperior tears. The Constant and UCLA scores were used to assess clinical outcomes. Anatomic and prognostic results were evaluated based on the physical examination, preoperative and postoperative imaging study findings, and anatomic lesions. Clinical data were available for 103 patients after at least 1 year of follow-up and radiological data for 129 patients after at least 6 months. RESULTS: The preliminary clinical results in 103 patients with at least 1 year of follow-up showed overall statistically significant improvements in the Constant and UCLA scores, with resolution of the clinical manifestations. The degree of improvement seemed to increase over time. The clinical results varied significantly across patient groups based on a classification system distinguishing four lesion types. Postoperative imaging studies to assess the anatomic results in all patients with at least 6 months of follow-up (n=129) showed tendon healing in 92% of cases but also indicated muscle wasting of the upper subscapularis muscle in 18.6% of cases and increased fatty degeneration of the muscle belly. DISCUSSION: Our study confirms the good clinical and radiological results reported in the literature. Our classification system distinguishing four lesion patterns was applicable during the imaging workup. The main finding from this classification system was the difference in results between Type 2 and Type 3 lesions. The trend towards improvements over time requires confirmation by longer-term studies, which will also have to establish that the increased wasting of the upper subscapularis muscle and fatty degeneration of the muscle belly have no adverse effects.

Diagnosis of subscapularis tendon tears: are available diagnostic tests pertinent for a positive diagnosis?

HYPOTHESIS: Clinically, subscapularis tendon tears are suggested by the presence of increased passive external rotation compared to the opposite side, resisted internal rotation manoeuvres (Lift-Off test [LOT], Belly-Press test [BPT], Napoleon test and Bear-Hug test [BHT] and positive Internal Rotation Lag Sign and/or Belly-Off Signs). Associated bicipital involvement is frequent with subscapularis tendon tears, because it participates in the formation of the biceps pulley. The Palm-Up test (PUT) is used for the biceps, and the Jobe test for the supraspinatus. MATERIAL AND METHODS: In this multicenter study, we evaluated the positive diagnostic value of the clinical tests, LOT, BPT, BHT, PUT, and the Jobe test for subscapularis tears as well as their anatomical value. The relationships of the different parameters studied were compared statistically by analysis of variance (ANOVA). This prospective multicenter study was performed from January 2009 to February 2010 and included 208 cases of subscapularis tendon tears, isolated or associated with partial (Ellman 1, 2 or 3) or full thickness (SFA stage 1) supraspinatus tears. RESULTS: The severity of the subscapularis tear was quantified according to the SFA classification into four stages and according to the level of injury (the lower 1/3 and upper 2/3). The three tests LOT, BPT and BHT were correlated to the severity of observed tears (P<0.05). The more deficient the test results were, the more severe the anatomical damage. The LOT is the test that cannot be performed most often (18%) but when it is positive, it is predictive of very severe tears. The BHT is the most sensitive of all tests (82%). The frequency of biceps involvement was correlated to the severity of subscapularis damage. There was no significant correlation between biceps involvement and subscapularis tests, or between supraspinatus involvement and subscapularis tests. There was no correlation between the Palm-Up test and subscapularis tears with associated supraspinatus involvement however, it was significantly correlated to biceps involvement (P<0.05). The Jobe test was disappointing because it was often positive even for isolated subscapularis tears. CONCLUSION: Even though all three tests were performed (LOT, BPT, BHT), 24% of the subscapularis tears were only diagnosed during surgery. The role of the Internal Rotation Lag Sign and Belly-Off Sign in improving the diagnosis of tears was not studied in this work.

New endoscopic classification for subscapularis lesions.

BACKGROUND: The absence of a coherent classification system has hampered communication about the treatment and outcomes of the various types of subscapularis tendon lesions. In addition, a reliable classification system allows comparisons of epidemiological and therapeutic data. The classification systems used until now fail to incorporate the radiological and intraoperative abnormalities of the bicipital sling, and they do not consider the degree of subscapularis tendon cleavage. Here, we describe a new arthroscopy-based classification system intended for therapeutic and prognostic purposes. METHODS: A prospective multicentre study sponsored by the French Society for Arthroscopy was conducted from March 2010 to January 2011 in 150 isolated subscapularis lesions with or without limited anterosuperior involvement. The bicipital sling and insertion of the deep subscapularis layer were routinely investigated by arthroscopy with video recording. Each lesion was classified after a consensus was reached among four surgeons. RESULTS: We identified four lesion types based on the bicipital sling findings. Type I was defined as partial separation of the subscapularis tendon fibres from the lesser tuberosity with a normal bicipital sling. Type II consisted of a partial subscapularis tear at the lesser tuberosity attachment combined with partial injury to the anterior wall of the bicipital sling, without injury to the superior glenohumeral ligament. Type III was complete separation of the subscapularis fibres from the lesser tuberosity with extensive cleavage of the bicipital sling. Finally, in Type IV, all the subscapularis fibres were detached and, in some cases, conjunction of the subscapularis and supraspinatus fibres produced the comma sign. Nearly all the lesions identified intraoperatively during the study fit one of these four types. DISCUSSION: A reproducible classification system that allows different surgeons to establish comparable homogeneous patient groups is useful for both therapeutic and prognostic purposes. We defined four types of subscapularis lesions that are easy to identify as either isolated lesions or combined with anterosuperior rotator cuff tears. Long head of biceps tendon abnormalities and fatty degeneration of the shoulder muscles can be added to our classification system. Studies of intraobserver and interobserver reproducibility are needed to complete the process of validating the diagnostic and/or prognostic usefulness of this new classification scheme.

Metastases of clinically occult testicular seminoma mimicking primary extragonadal retroperitoneal germ cell tumors.

BACKGROUND: Whether extragonadal germ cell tumors develop primarily in the retroperitoneum or whether they are essentially metastases of a primary testicular tumor has long been debated and remains controversial. PATIENTS AND METHODS: Three patients presenting with apparent primary extragonadal retroperitoneal germ cell tumors are reported. Ipsilateral testicular evaluation was extended with palpation, ultrasonography and finally histological examination. RESULTS: The retroperitoneal extragonadal tumors were found during abdominal MSCT. It was a fortuitous finding in the two first patients.The third patient presented with abdominal pain attributed to necrosis of the large mass which was subsequently firstly drained through endoscopic ultrasound-guided transduodenal puncture. The seminomatous nature of the retroperitoneal tumors was obtained through transduodenal echoendoscopic-guided cytopuncture in the first case, celioscopic resection in the second case and delayed percutaneous CT guided biopsy in the third symptomatic case. The first two patients had a history of cryptorchidism with substantial clinical testicular atrophy; ultrasonography showed microlithiasis and a small intratesticular tumor in the first patient and an hypoechoic but rather homogeneous atrophic testis in the other; orchiectomy confirmed small seminomatous intratesticular tumors in the two cases. The third patient had an atypical hypoechoic area on testicular ultrasound and histopatholgy revealed a burn-out primary tumor. CONCLUSIONS: So-called primary extragonadal retroperitoneal germ cell tumors are extremely rare and should first be considered as metastases of a viable or burned-out testicular cancer until proven otherwise. All ipsilateral testicular abnormalities revealed by the patient's history, clinical examination and mostly by testicular ultrasound must be treated adequately with orchiectomy because they may act as a sanctuary for later tumor growth.

Renal pelvis haemangioma demonstrated by MSCT urography with ureteral compression and 3D reconstruction.

A rare case of renal haemangioma of the renal pelvis is reported. The 40-year-old patient classically presented with recurrent hematuria. The small pyelic tumour was clearly delineated by msCT urography obtained during compression of the uretera with rubber balloons classically used during IVP In the absence of a definite histological diagnosis--pyeloscopy being unsuccessful--the patient underwent radical nephrectomy. The literature concerning renal haemangioma is briefly reviewed and the role of compression assisted msCT urography as a possible method for the detection of small pyelocaliceal tumours is emphasized.

[Exercise-induced acute bilateral isolated anterolateral compartment syndrome of the leg: a case report of a rare condition]. / Syndrome de loge d'effort de jambe antéro-latéral isolé, aigu et bilatéral. Une entité clinique rare: à propos d'un cas.

Acute compartment syndrome of the leg is generally a consequence of trauma. Exercise-induced acute compartment syndrome of the leg is an exceptional clinical entity observed in the context of a chronic compartment syndrome or as an isolated acute syndrome subsequent to an intense effort. Our patient was a young athlete with no history of exercise-induced leg pain. Following a soccer game, he developed an acute leg syndrome involving the anterolateral compartment of both legs. The diagnosis was not suggested by the patient's history (no notion of chronic compartment syndrome) nor the natural history of the condition but was retained on the basis of the clinical presentation and course then confirmed by intramuscular pressure measurements. Emergency treatment by fasciotomy under general anesthesia in the operating room led to cure with no sequela. The fasciotomy was closed on day 9 with simple skin sutures. Surgeons should be aware that acute exercise-induced compartment syndrome (with the risk of severe functional consequences) may be the cause of unexplained intense leg pain. The diagnosis is established on the basis of clinical findings and measurement of intramuscular pressures. Pain is the cardinal sign, sometimes associated with sensorial deficit. The compartment is hard and painful at palpation. Passive stretching exacerbates the pain. Compartment pressure is required for certain diagnosis, most Authors accepting > 30mmHg as a positive test. Emergency fasciotomy is required.

[Validation of an experimental protocol of an optoelectronic analysis of continuous active knee kinematics in vitro]. / Validation d'un protocole expérimental d'étude optoélectronique de la cinématique active continue de l'articulation du genou in vitro.

PURPOSE OF THE STUDY: In vitro experiments are particularly useful for studying kinematic changes in the normal knee exposed to experimental conditions simulating different disease states. We developed an experimental protocol allowing a kinematic analysis of the femorotibial and femoropatellar joints in healthy knees and after implantation of a knee prosthesis, using a central pivot to simulate active loaded movement from the standing to sitting position. EXPERIMENTAL SETUP: An experimental device was designed to apply force to the femur of a cadaveric specimen including the femur, the patella and the tibia. The tibia was angled in the sagittal plane and the femur was free to move in space in response to the geometric movement of the knee joint, the capsuloligamentary structures, the quadriceps tendon and gravity. Variation in the length of the quadriceps tendon controlled the flexion-extension movement. The experimental setup included computer-controlled activation allowing continuous coordinated movement of the femur relative to the tibia and of the tibia relative to the ground. Standard activations simulated movement from the standing to the sitting position. STUDY PROTOCOL: Five pairs of fresh-frozen cadaver specimens including the entire femur, patella, tibia and fibula, the capsuloligamentary and intra-articular structures of the knee, the superior and inferior tibiofibular ligaments and the quadriceps tendon were studied. The quadriceps tendon was connected to the computer-guided activation device. Reflectors were fixed onto the anterior aspect of the femur, the superior tibial epiphysis and the center of the patella. Anatomic landmarks on the femur, the tibia, and the patella were identified to determine the plane of movement of each bone in the three rotation axes and the three translation directions. Three infrared cameras recorded movements of the reflectors fixed on the bony segments and, by mathematical transformation, the movement of the corresponding bony segment, displayed in time-course curves. RESULTS: The precision of the measurements, evaluated in a previous study, was +/- 1.5 degrees for rotation and +/- 0.5 mm for translation movements. Three acquisitions were made for each experiment and produced results differing less than one degree. A qualitative analysis of femorotibial and femoropatellar kinematics was achieved for the normal knee. The automatic internal rotation of the femur during flexion was observed and the patellar kinematics were defined with six degrees of freedom. DISCUSSION: This experimental setup enables a comparison of the kinetics of a normal knee with the kinetics observed after implantation of a prosthesis on the same knee. The kinetic analysis does not involve a succession of static states but rather a continuous movement generated by the action of the quadriceps that can be loaded, simulating partial weight bearing. Using the markers fixed directly on the bones, this in vitro study allowed remarkably precise and reproducible measurements. The movements simulated regularly encountered clinical situations. The quality of the movement recorded for a given prosthesis thus provides an accurate approach to the quality of the prosthesis. The goal is not to define the exact kinematics of the normal knee but rather to compare the kinematics of the normal knee with that of the same knee after prosthesis implantation allowing an accurate method for assessing prosthesis design and studying the influence of different parameters, particularly the ligaments. Concomitant study of femorotibial and femoropatellar kinematics provides further information rarely found in the literature.

[In vitro analysis of the continuous active patellofemoral kinematics of the normal and prosthetic knee]. / Etude de la cinématique active continue de l'articulation fémoropatellaire d'un genou normal ou porteur d'une prothèse in vitro.

PURPOSE OF THE STUDY: In vitro experiments are particularly useful for studying kinematic changes from the normal knee to experimental conditions simulating different disease states. We developed an experimental protocol allowing a kinematic analysis of the femorotibial and femoropatellar joints in the healthy knee and after implantation of a knee prosthesis, according to the central pivot during simulated active loaded movement from the standing to sitting position. EXPERIMENTAL SETUP: An experimental device was designed to apply force to the femur of a cadaveric specimen including the femur, the patella and the tibia. The tibia was angled in the sagittal plane and the femur was free to move in space in response to the geometric movement of the knee joint, the capsuloligamentary structures, the quadriceps tendon and gravity. Variation in the length of the quadriceps tendon controlled the flexion-extension movement. The experimental setup included computer-controlled activation allowing continuous coordinated movement of the femur relative to the tibia and of the tibia relative to the ground. Standard activations simulated movement from the standing to the sitting position. STUDY PROTOCOL: Five pairs of fresh-frozen cadaver specimens including the entire femur, patella, tibia and fibula, the capsuloligamentary and intra-articular structures of the knee, the superior and inferior tibiofibular ligaments and the quadriceps tendon were studied. The quadriceps tendon was connected to the computer-guided activation device. Reflectors were fixed onto the anterior aspect of the femur, the superior tibial epiphysis and the center of the patella. Anatomic landmarks on the femur, the tibia, and the patella were identified to determine the plane of movement of each bone in the three rotation axes and the three translation directions. Three infrared cameras recorded movements of the reflectors fixed on the bony segments and, by mathematical transformation, the movement of the corresponding bony segment, displayed in time-course curves. RESULTS: The patella moved in continuous fashion over the femur, directly following the angle of knee flexion with a ratio of about 60%, which was constant for all knees studied and for all configurations. The patella of healthy knees and knees implanted with a unicompartmental prosthesis exhibited medial rotation during the first 30 degrees of flexion, with a movement of about of 10 degrees, then a lateral rotation of about 10 degrees to 20 degrees when the flexion reached 90 degrees; implantation of a total knee prosthesis led to a medial rotation which was continuous from 5 degrees to 15 degrees. There was a trend towards continuous abduction of about 10 degrees. The patella exhibited a continuous anterior translation of 10 to 20 mm from the tibia with increasing knee flexion, in both normal and prosthetic knees (unicompartmental prosthesis); knees implanted with a total knee prosthesis exhibited 5 to 10 mm anterior translation from 0 degrees to 50 degrees flexion, then an equivalent posterior translation for 50 degrees to 90 degrees flexion. The patella made a continuous 5 to 10 mm medial translation movement over the tibia in both normal and prosthetic (unicompartmental) knees; knees implanted with a total knee prosthesis exhibited 0 to 5 mm lateral translation starting after 50 degrees flexion. The patella also exhibited a continuous distal translation over the tibia of about 20 to 30 mm, for all configurations. DISCUSSION: The experimental set up enables a comparison of the kinetics of a normal knee with the kinetics observed after implantation of a prosthesis on the same knee. Implantation of a unicompartmental medial prosthesis, leaving the posterior cruciate ligament intact and irrespective of the status of the anterior cruciate ligament, did not, in these experimental conditions, exhibit any significant difference in the femorotibial or femoropatellar kinetics compared with the same normal knee. Implantation of a total knee prosthesis had a significant effect on the femoropatellar kinematics, compared with the same knee before implantation. The main anomalies were related to the medial-lateral rotation of the patella which exhibited an abnormal lateral rotation, possibly favorable for subluxation; these changes were directly related to femorotibial rotation after implantation of the total prosthesis and appeared to be related to the symmetry of the femoral condyles of the prosthesis model studied, perturbing the normal automatic rotation of the knee. There is thus a strong relationship between femorotibial and femoropatellar kinetics in the total knee prosthesis.

[Traumatic bilateral rotatory C1-C2 dislocation in an adult: case report and review of the literature]. / Luxation rotatoire bilatérale traumatique C1-C2 de l'adulte: une observation et revue de la littérature.

Trauma led to bilateral rotatory atlantoaxial dislocation in a 23-year-old woman. Clinical diagnosis of this uncommon dislocation of the cervical spin is generally difficult and often made late. Typical signs include pain in the upper cervical spine and a fixed rotated position of the head. Integrity of the transverse ligament of the atlas is a determining factor for atlantoaxial stability and allows orthopedic treatment after reduction using moderate traction on the head. As for most authors, orthopedic was successful in our patient who totally recovered cervical spine mobility without pain.

US and CT diagnosis of complete cecocolic intussusception caused by an appendiceal mucocele.

Appendiceal mucoceles are found in only 0.2-0.3% of all appendectomy materials. Colocolic intussusception of the appendix is also very uncommon. We report the very rare association of these two entities in a 40-year-old patient presenting with intermittent right abdominal pain accompanied by a palpable mass in the right flank. The full diagnosis was made preoperatively by ultrasound and confirmed by helical CT by means of unequivocal signs of intussusception associated with a very suggestive "cup-and-ball" aspect of the mucocele induced by a global mucinous cystadenoma of the appendix. A brief review of the available literature on mucocele is given.

[Failure of acetabular cups fixed with cement and thick embedded wire mesh]. / Echec d'une armature métallique grillagée pour le scellement acétabulaire.

PURPOSE OF THE STUDY: We report our experience with the SKH(R) cemented acetabular cup, analyzing the clinical and radiographic consequences of using cement armed with a thick embedded wire mesh. MATERIAL AND METHODS: Between June 1990 and June 1991, 118 total hip arthroplasties (THAs) were performed in 110 patients (8 bilateral cases) using the SKH(R) cemented acetabular cup, a self-blocking cemented femoral stem with anterograde injection made of a Ti-6Al-7Nb alloy and a 28 mm ceramic polyethylene articulation. Mean follow-up for 97 implants (91 patients) was 7.1 years (3 - 9 years). Mean age at implantation was 65 years (36 - 85 years) (43 men and 48 women). THAs were performed for degenerative joint disease (n=79) including 67 cases of primary disease, necrosis (n=11), rheumatoid disease (n=6), and fracture of the femoral neck (n=1). RESULTS: For the 118 procedures, there were 4 complications: 2 dislocations (no revision), one failure of the ceramic head and one implant infection (with revision). As assessed by the Postel-Merle-d'Aubigné score as modified by Charnley for the mobility criterion, clinical outcome was excellent or good in 82% of the cases, fair in 11% and poor in 7%. According to the Massin criteria at last follow-up, there were 13 cup loosenings (13.4%, 10 migrations and 3 total lucent lines > 1 mm); revision procedures were performed in 6 cases. A lucent line postoperatively, observed in 51% of the cases (p=0.025) and involving all or part of zone 1 in 44% (p=0.047), was predictive of acetabular failure. Linear polyethylene wear as measured manually was 0.08 mm/year (average) for non-loosened cups and 0.2 mm/year for loosened cups; the difference was significant (p=0.001). On the contrary, the thickness of the cement, measured at the limits of the three De Lee and Charnley zones, cup tilt and size, age, weight and patient activity level had no effect on failure rate. Actuarial survival of the cup at 9 years was 86.3% taking aseptic loosening (with or without revision) as the failure criterion and 93.8% taking revision for aseptic loosening as the failure criterion. DISCUSSION: These results were rather disappointing. The thick layer of cement reinforced with the wire mesh produces a metal back effect with the known consequences in terms of loosening, cement-bone lucent line, and polyethylene wear. A modification is now undergoing thermal and mechanical assessment. A thinner and tighter mesh would appear to be preferable.

[Bilateral subtotal scapulectomy for chondrosarcoma in Ollier's disease within a 16-year interval]. / Scapulectomie subtotale bilatérale à 16 ans d'intervalle pour dégénérescence maligne d'enchondromatose multiple d'Ollier.

PURPOSE OF THE STUDY: We report the case of a young man with Ollier's disease who underwent three successive procedures for sarcomatous degeneration of some of his endochondromatous lesions. From the age of twenty, the patient required surgery for resection of a cartilage tumor of the body of L5, amputation of the right index finger, and successive right then left subtotal scapulectomy. At 40 years, the patient presents other stable lesions, mainly located on the right side of the body. We were particularly interested in the functional outcome of the two shoulders in this patient who continues to have normal social and occupational activities.

[Reconstruction by graft and reinforcement device in severe aseptic acetabular loosening: 10 years survivorship analysis]. / Reconstruction par greffe et anneau de soutien des descellements acétabulaires aseptiques avec perte de substance osseuse sévère. Analyse actuarielle sur 10 ans.

PURPOSE OF THE STUDY: We report our experience with the treatment of aceptic acetabular loosening with important loss of bone stock using a graft and a metallic reinforcement device. MATERIAL AND METHOD: We carried out a retrospective study on 56 acetabular revision arthroplasties with severe loss of bone stock performed between November 1980 and June 1992. Mean age of the 35 females and 19 males was 68.5 years. In all cases, there was a combined lesion (cavity + segmentary) of two roofs (type 3 or 4 in the SOFCOT classification). The superior wall was concerned in all cases (80 p. 100 with a combined lesion). Reconstruction was performed using grafts (autograft (n=15), allograft (n=39) or both (n=2)) covering more than 50 p. 100 of the socket. Structural grafts were embedded into the defects in case of superior combined lesion with extension to the anterior and the posterior walls. A morselized graft was used to fill other defects. The reinforcement device was a Müller ring (n=35) or the Burch-Schneider APC (n=21). Mean follow-up was 8.75 years (range 3 - 16 years). RESULTS: There were 29 iterative aseptic loosenings of acetabular component revised or non-revised (n=11). Twenty-four of these cases had a Müller ring and 5 had a Burch-Schneider APC. The 10-year cumulative survival rate (CSR) was 0.43 +/- 0.16 and the 11-year CSR was 0.350.16 using iterative aseptic loosening as the end point. The lateral position of the hip center (p=0.02), female gender (p=0.03), and the Müller ring (p=0.0054) were statistically negative factors. The 10-year CSR was 0.44 +/- 0.18 for the Müller ring and 0.78 +/- 0.1 for the Burch-Schneider APC, the difference being statistically significant (p=0.007). These two populations were strictly comparable. CONCLUSIONS: In case of important loss of bone stock, reconstruction by grafts is widely used as reported in the literature. A metallic reinforcement device must be used to protect the graft during incorporation and to prevent late resorption. Compared with the Müller ring, the Burch-Schneider APC is much more adapted to meet these requirements, particularly when the graft covers more than 50 p. 100 of the socket.

Glucocorticoid receptor homodimers and glucocorticoid-mineralocorticoid receptor heterodimers form in the cytoplasm through alternative dimerization interfaces.

Steroid hormone receptors act to regulate specific gene transcription primarily as steroid-specific dimers bound to palindromic DNA response elements. DNA-dependent dimerization contacts mediated between the receptor DNA binding domains stabilize DNA binding. Additionally, some steroid receptors dimerize prior to their arrival on DNA through interactions mediated through the receptor ligand binding domain. In this report, we describe the steroid-induced homomeric interaction of the rat glucocorticoid receptor (GR) in solution in vivo. Our results demonstrate that GR interacts in solution at least as a dimer, and we have delimited this interaction to a novel interface within the hinge region of GR that appears to be both necessary and sufficient for direct binding. Strikingly, we also demonstrate an interaction between GR and the mineralocorticoid receptor in solution in vivo that is dependent on the ligand binding domain of GR alone and is separable from homodimerization of the glucocorticoid receptor. These results indicate that functional interactions between the glucocorticoid and mineralocorticoid receptors in activating specific gene transcription are probably more complex than has been previously appreciated.

[Straight femoral taper in cementless primary total hip replacement in less than 65 year-old patients: multicenter study of 115 consecutive implantations at mean 8,2 year follow-up]. / Comportement d'une tige fémorale droite en arthroplastie totale primaire non cimentée de la hanche chez les patients de moins de 65 ans.

PURPOSE OF THE STUDY: The Swedish Arthroplasty Registry experience with cemented primary total hip arthroplasty (THA) has pointed out age below 65 and high activity level as 2 major factors impairing THA long-term outcome. The aim of this study was to provide intermediate results of cementless femoral replacement in primary THA with use of the Alloclassic-SL grit-blasted titanium stem in "high risk" groups of patients. MATERIAL AND METHODS: From June, 1988 to June, 1992, 127 cementless primary THA's were consecutively performed in<65 year old patients in 2 institutions. Acetabular components were all cementless (threaded cup in 74%) and bearing surfaces were all alumina-ceramic 28mm heads on polyethylene (PE). Five patients (6 hips) died and 6 other hips were lost to follow-up before the 5-year minimum follow-up. Thus, 115 hips in 106 patients could be fully reviewed after a 8.2 year average follow-up period (range, 5 to 12 years). Mean age at surgery of the 62 male and 44 female patients was 52 years (range, 27 to 65 years). RESULTS: Of the index group (127 hips), intra-operative fracture of the greater trochanter and early dislocation were noted in 4.7% and 3.2% of hips, respectively. Of the study group (115 hips), clinical results according to the Merle d'Aubigné and Charnley rating system were graded excellent and good in 94% of hips and fair in 6% (7 hips), with no poor result. Radiologically, early subsidence of more than 2mm could be detected in 8 hips (7%). Calcar atrophy and spot welds were noted in 81% and 89% of hips, respectively. Proximal reactive and lucent lines and mild proximal stress shielding were observed in 10.5% and 4.3% of hips, respectively. Ten-year survivorship with stem revision for any reason as the end point was 99.2% (92.4-99.9) (1 stem exchanged and reoriented for immediate dislocation). One revision is pending for extensive femoral osteolysis due to polyethylene (PE) wear. There was no stem fracture and no ceramic head breakage thus far. Overall PE-wear rate ranging 1-2 mm was detected in 13 hips (9.6%) and femoral osteolysis in 4 hips (3.5%). DISCUSSION: Mid-term results of this cementless straight taper at 10 year are at least equal to those of well performing cemented components, even in "high risk" groups of patients. Conversely, 28mm alumina-ceramic heads can reduce but not prevent the occurrence of PE-wear in such a healthy and active population. CONCLUSION: Press-fitting but not filling the femoral canal with rough titanium straight tapers like the Alloclassic-SL femoral component represent a promising alternative to modern femoral cementing technique in primary THA. Improvement is expected through the use of more wear resistant bearing surfaces.

[Arthroscopic treatment of acetabular labrum lesions: a series of 12 patients with a 4-year follow-up]. / Traitement arthroscopique des lésions du labrum acétabulaire. A propos de 12 patients avec un recul moyen de 4 ans.

PURPOSE OF THE STUDY: The aim of this work was to report our experience with arthroscopy for the treatment of acetabular labral lesions and identify prognostic factors determining mid- and long-term outcome. MATERIAL AND METHODS: Between August 1991 and December 1997, 12 patients (ten women, two men, mean age 39 years, age range 25-61 years) underwent arthroscopic treatment of an acetabular labrum lesion. All were reviewed at a mean 4 years follow-up (18 months-8 years). Half of the patients (n =6) had a history of hip surgery: two femoral osteotomies and one acetabular bone block for congenital hip dislocation, two high-energy traumas and one traumatic dislocation. Clinical manifestations including pain (n =12), a sensation of a snag (n =10), or blockage (n =8) had developed over a mean 15 months (2-24 months). Standard x-rays evidenced early signs of degenerative disease in four cases and acetabular dysplasia in four (5 degrees

Optical Spectroscopy of Diatomic Species: Copper with Group 14 Elements (Si, Ge, Sn, Pb).

Electronic band systems of the gaseous diatomic compounds of copper and various X elements of the 14th column (Si, Ge, Sn, Pb) have been observed by thermal excitation in the red part of the visible spectrum. Vibrational analysis of the two subsystems observed for each of these molecules (except for CuPb with only one system) are reported and assigned as (2)Sigma(+)-(2)Pi(3/2) and (2)Sigma(+)-(2)Pi(1/2) transitions. The variation of the spin-orbit splitting of the (2)Pi lower states from CuSi to CuSn follows closely that of the np shell spin-orbit parameters in the group 14 atoms. This fully corroborates previous ab initio calculations that predict a (2)Pi(r) ground state with the ionic Cu(+) (3d(10))X(-)(pvarsigma(2)ppi) configuration for these molecules. Copyright 2000 Academic Press.