Case reports of medication-related osteonecrosis of the jaw (MRONJ) treated with uncultured stromal vascular fraction and L-PRF.

Medication-related osteonecrosis of the jaw (MRONJ) is a challenging affection, considering the absence of a "Gold Standard" treatment. Cell therapy and tissue engineering, using adipose-tissue stromal vascular fraction (SVF) containing mesenchymal stromal cells (MSC) and endothelial progenitor cells (EPC); and a scaffold with healing properties, l-platelet-rich fibrin (L-PRF), could be a therapeutic option. Two cases of MRONJ were treated by tissue engineering. The patients presented respectively a stage-II and a stage-III MRONJ. The protocol consists of SVF injection in the L-PRF applied on the cleaned bone. Patients are followed clinically and by medical imaging (MI) for 18 months. The buccal mucosa was closed within a month. No recurrence was observed during the follow-up. The MI highlighted bone formation. MSC and EPC presence, in the SVF, were confirmed by immunophenotyping. We report the preliminary results of MRONJ patients successfully treated with the association of autologous fresh L-PRF-SVF.

Fistula and stenosis after 135 (pharyngo)laryngectomies.

BACKGROUND: Despite progress made with reconstruction, morbidity is still elevated after (pharyngo)laryngectomy. The present study was designed to determine the incidence and predisposing factors of the complications following (pharyngo)laryngectomy. METHODS: Primary surgical treatment was delivered in 60 patients. Seventy-five patients underwent surgical salvage following radiotherapy. Different factors were evaluated as potentially predisposing to fistula formation. RESULTS: Stenosis is rare: 5.1% in the present series. A pharyngocutaneous fistula developed in 48.8% of patients. After a multivariate analysis, the site of the tumour was defined as a significant risk factor for pharyngocutaneous fistula formation. CONCLUSIONS: Despite progress made with reconstruction, morbidity is still elevated after major resection of the phary golarynx. Stenosis, a frequent complication when partial pharyngectomy is needed, is rare: 5.1% in the present series. Fistulas are relatively frequent but the majority resolved either with local irrigation or with subsequent flaps. The site of the tumour was a significant risk factor for pharyngocutaneous fistula formation, as defined by a multivariate analysis.

Presacral hemorrhage: a rare complication of colonoscopy.

The Authors describe a case of presacral hemorrhage after a colonoscopy in a patient taking anticoagulation. Surgical treatment was necessary to stop the hemorrhage.

Aortoduodenal fistula following aortobifemoral bypass.

A patient with a fistula between the aortic graft and the third portion of the duodenum was admitted in our institution and submitted to surgery that involved extra anatomical axillobifemoral bypass, prosthesis removal and bowel resection with a gastrojejunal Roux anastomosis. A prosthetic fistula after aortic surgery is a rare but potentially fatal complication. Erosion, infection and pseudoaneurysm are mechanisms in the pathogenesis of aortoenteric fistula. Because of the high mortality and morbidity, associated with secondary aortoenteric fistula, surgical treatment is always recommended. A combination of endoscopy and CT or MRI may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion. An aortoenteric fistula should always be suspected in all patients who have undergone aortic graft surgery and present with gastrointestinal haemorrhage. The authors discuss the modern management of this challenging complication of aortic surgery.

S100A8 and S100A9 calcium-binding proteins: localization within normal and cyclosporin A-induced overgrowth gingiva.

S100A8 and S100A9, also called myeloid related protein (MRP) 8 and 14, are calcium-binding proteins highly expressed in neutrophils, in which they play a key role in the inflammatory progression. In this study, we looked at the expression of S100A8/A9 within gingiva from normal and Cyclosporin A (CsA)-induced overgrowth gingiva. In gingiva from the CsA group, several positive S100A8/A9 cells were seen within the connective tissue, whereas in normal gingiva very few positive S100A8/A9 cells were detected. These cells correspond either to activated macrophages or to neutrophils, reflecting the well-known gingival inflammatory status associated with the CsA-treated group. In addition, in both the normal and drug-treated group, the gingival epithelia appeared S100A8/A9 immunopositive. More specifically, S100A8/A9 appeared in the majority within the spino-cellular layer and located extracellularly within the desmosomes. In addition, S100A8/A9 also appeared sporadically intracellularly, located within the cytoplasm and the nuclei, reflecting S100A8/A9 translocations.

[Large intraperitoneal leiomyosarcoma. Report of a case and review of the literature]. / Volumineux léiomyosarcome intrapéritonéal. Rapport d'un cas et revue de la littérature.

The leiomyosarcoma are rare tumors, accounting for only 0.1% to 3% of all gastrointestinal malignancies. 150 new cases are diagnosed annually in the United States. The spectacular character of leiomyosarcoma consists in its measurements, its size reaching 35 x 25 x 17 cm, its weight 5.5 kg, and in the asymptomatic character of the tumor. The final diagnosis, although suspect with preoperative diagnostic procedure, is obtained after histologic examination. Complete surgical excision is the best treatment, the role of radiation therapy and chemotherapy are not yet established.

An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament.

Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment.

Laparoscopic cholecystectomy for acute cholecystitis in geriatric patients.

Although acute cholecystitis (AC) in many centers is routinely treated by laparoscopic cholecystectomy (LC), the outcome of LC for AC in geriatric patients (75 years or more) remains almost unstudied. All 32 geriatric patients undergoing a cholecystectomy for histologically proven AC in a teaching hospital during a six-year period were studied retrospectively. Median preoperative duration of symptoms was eight days and median preoperative hospital stay was six days. Preoperative ERCP was performed in 22 patients with successful sphincterotomy and common bile duct (CBD) stone retrieval in 11 patients. Overall twelve patients (37%) had CBD stones and 14 patients (44%) had gangrenous cholecystitis at operation. Twenty-seven patients underwent a LC with a conversion rate of 26%, a complication rate of 41% and a mortality rate of 3.7%. Five patients were judged unstable for a laparoscopic approach and underwent a straight open cholecystectomy. Although the latter were at higher risk (higher APACHE II scores), their outcome except for longer intensive care unit stays, was not different from laparoscopically treated patients. Lack of superiority of laparoscopic over open cholecystectomy in the present study seemed due to clinical characteristics of AC in geriatric patients which may lead to late diagnosis and treatment. Preoperative ERCP by further delaying surgery may contribute to loose any potential benefit of an early laparoscopic procedure. The place of preoperative ERCP and the timing of LC in geriatric patients with AC therefore may need to be redefined.

[Giant cystadenoma of the ovary in an adolescent: clinical case and review of the literature]. / Cystadénome géant de l'ovaire chez l'adolescente: cas clinique et revue de la littérature.

We report a case of a young adolescent girl presenting a giant ovarian cyst. We believe that this is one of the biggest ovarian cysts reported in the literature until now. About this observation, a literature review concerning diagnosis and treatment of ovarian mucinous cystadenoma in the young girl is done.

Homocamptothecin, an E-ring-modified camptothecin, exerts more potent antiproliferative activity than other topoisomerase I inhibitors in human colon cancers obtained from surgery and maintained in vitro under histotypical culture conditions.

Topoisomerase I (Topo I) is overexpressed in cancer colon tissues compared with normal colon tissues. Several anti-Topo I inhibitors are already successfully used in the clinic. We illustrate here the antiproliferative activity of a new class of Topo I inhibitors, i.e., E-ring-modified camptothecins with enhanced lactone stability (L. Lesueur-Ginot et al., Cancer Res., 59: 2939-2943, 1999). Forty-three human colon cancers were obtained from surgical resection and maintained under organotypical culture conditions for 48 h. Cell proliferation was assessed in these ex vivo tumor tissue cultures by tritiated thymidine autoradiography. As a validation of the methodology, we first analyzed in our model the antiproliferative activity of two clinically active topoisomerase II (Topo II) inhibitors, Adriamycin and etoposide, which are not active for colon cancers; and three Topo I inhibitors, camptothecin (CPT) and two clinically active compounds (especially for colon cancers), i.e., topotecan and the active metabolite of irinothecan, SN-38. We then compared the antiproliferative activity of CPT, topotecan, and SN-38 against those of two investigational E-ring-modified camptothecins, i.e., BN80245 and BN80915. Three concentrations (1, 10, and 100 nM) were studied for each compound. The results indicate that the three Topo I inhibitors used as references, i.e., CPT, irinothecan, and SN-38, were much more active than the two Topo II inhibitors, i.e., Adriamycin and etoposide, with SN-38 being the most efficient. The two investigational compounds BN80245 and BN80915 exerted higher antiproliferative activity than the three anti-Topo I reference compounds, with the highest activity observed for BN80915.

Metastatic involvement of ceco-appendicular segment: a diagnosis of right lower quadrant abdominal pain in patient receiving chemotherapy.

Metastases are a common feature during the evolution of breast cancer. However, gastrointestinal metastases, and especially ceco-appendicular ones, are very rare. Melanoma however frequently metastasize in the gastrointestinal tract. Ceco-appendicular metastases do not display any specific signs in cancerous patients. These rare metastases must be considered in the diagnosis of right lower quadrant pain in cancerous patients. The main differential diagnosis includes neutropenic enterocolitis, acute appendicitis, malignant intestinal obstruction and perforation of the bowel. The morbidity of gastrointestinal complications in patients with metastatic cancer receiving chemotherapy is significant and surgery is often the only chance of survival. The major clinical decision is whether or not to operate.

[Sebaceous carcinoma. Apropos of an extra-ocular location]. / Les carcinomes sébacés. A propos d'une localisation extra-oculaire.

Sebaceous carcinomas of the skin are rare tumors. They most often occur on the skin of the head and neck. Their clinical diagnosis is difficult and the evolution is unpredictable. Recurrence and metastasis are not rare. Treatment of choice is large surgical excision. Opinions are divided regarding the use of chemotherapy and radiotherapy. A case of cutaneous sebaceous carcinoma on the right side of the nose that occurred on a previously irradiated skin is described, with rapid metastasis to the right paramandibular region.

[Value of the velocimetry study of the uterine arteries in retro-placental hematoma. Report of 3 cases]. / Intérêt de l'étude vélocimétrique des artères utérines dans l'hématome rétro-placentaire. A propos de 3 observations.

Retroplacental hematoma is a sudden accident with unfavorable prognosis, especially since predictive signs (clinical, biological or ultrasonographic) are very frequently absent. The purpose of this study was to determine whether velocimetric study of the uterine arteries is of predictive value in this pathology. The equipment used was Doppler ultrasound with spectral analysis (4-MHz probe) without echography. Each examination consisted in systematic study of both uterine arteries and of umbilical flow. The recording technique for the uterine arteries is described, and 3 cases of retroplacental hematoma are reported. In all 3 cases, the resistance index for one of the uterine arteries (right twice, left once) was high, with the presence of a (proto-diastolic notch on the curve, whereas the umbilical index was normal and there were no other signs predictive of the placental accident. The value of Doppler exploration has already been demonstrated for numerous obstetric indications, and it should be possible to include others, particularly if this preliminary study is confirmed on a larger scale.

[Value of a velocimetric study of the uterine arteries in retroplacental hematoma. 3 case reports]. / Intérêt de l'étude vélocimétrique des artères utérines dans l'hématome rétro-placentaire. A propos de 3 observations.

Retroplacental hematoma is a sudden event with a poor prognosis, the latter being aggravated by the very frequent lack of predictive clinical, laboratory or echographic signs. Does studying the velocity of blood flow in uterine arteries have a predictive value in this disease? The equipment used was a continuous Döppler with spectral analysis and probe of 4 MHz, without echographic identification. Each examination systematically included the study of the 2 uterine arteries and the umbilical flow. The technique for recording flow in the uterine arteries is described. A report is given of three cases of retroplacental haematoma. An increase in the resistance index in one of the uterine arteries was found in the three cases (twice on the right, and once on the left), with a protodiastolic notch on the curve, whereas the umbilical index itself was normal and there were no other sign that indicated the placental event. The Döppler is already known to be of value in numerous indications in obstetrics: it should be possible to extend these indications even further, particularly if this preliminary study is confirmed on a broader scale.

[The value of velocimetric investigation of the uterine arteries in retro-placental hematoma. 3 cases]. / Intérêt de l'étude vélocimétrique des artères utérines dans l'hématome rétro-placentaire. A propos de 3 observations.

Retro-placental hematoma is a sudden event with a serious prognosis which is aggravated by the very frequent absence of premonitory clinical, biological or ultrasonic signs. Does a velocimetric investigation of the uterine arteries have any predictive value in this disorder? The apparatus used was a continuous Doppler with spectral analysis and a 4 MHz probe no ultrasonic location. Each examination involved the exploration of 2 uterine arteries and of the umbilical flow. The method of recording the uterine arteries is described. Three cases of retro-placental hematoma are reported. In these three cases, an increase in the resistance index of one of the uterine arteries (the right artery in 2 cases and the left in 1 case) was detected with the presence of a protodiastolic notch on the trace, whereas the umbilical index itself was normal and no other sign was present which could predict the placental event. The value of the Doppler recording is already established in many obstetric indications, and these should be extended yet further, particularly if this preliminary study is confirmed on a larger scale.

[Free musculo-osseous flaps in maxillofacial surgery]. / Lambeaux musculo-osseux libres en chirurgie maxillo-faciale.

Development of microsurgery has involved the use of revascularized bone grafts in maxillo-facial surgery. They are essentially indicated in rebuilding of complex tissues lost including bone. Their utility is well know in maxillofacial surgery, cervico-facial cancerology, ballistics trauma and in the cure of some mandibular osteoradionecrosis. Only scapular and iliac autogenous bone transplants were used by the authors. Following their short experience, they preferred the pediculated iliac transplants on the deep circumflex vessels more easy to handle and more secure. They brought some modifications in the graft technics in order to decrease the functional and the esthetic damages at the donor site: the incisions were parallel to the iliac crest an to the crural arch. The transplant respected the integrity of the antero-superior-iliac-spine and the crural arch. At the receiving site the muscle was left denuded in the oral cavity. The reepithelialization was observed in a short time.

[Revascularized bone grafts. Technics, indications and results]. / Greffes osseuses revascularisées. Techniques, indications et résultats.

The development of microvascular surgery has allowed the transfer of revascularized bone grafts. The surgical techniques of the most useful transfers are explained. The advantages, disadvantages and indications of these procedures, as compared with the other techniques of bone reconstruction, are discussed.

[Infection with lymphadenopathy associated virus. Clinical case report in a child]. / Infection à "lymphadenopathy associated virus". Observation clinique chez l'enfant.

The authors describe the case of a little girl from Zaïre presenting a proven HTLVIII infection. The interest of this observation lies in the fact that the clinical symptoms, leading to this diagnosis, fall within the competence of stomatology.