Effect of haemodilution on transfusion requirements in liver resection.

Between April, 1988, and February, 1989, 22 consecutive patients underwent liver resection (17 hepatectomy, 5 segmentectomy) with intraoperative haemodilution to avoid blood transfusion. The results were compared with those of 22 patients who underwent liver resection without haemodilution between February, 1987, and April, 1988, and who were matched for the nature of the tumour and the type of liver resection. Age, preoperative haematocrit and haemoglobin concentration, and intraoperative blood loss did not differ between the groups who did and did not undergo haemodilution. There was no abnormal bleeding during liver transection in haemodiluted patients. No allogeneic blood products at all were needed in a significantly greater proportion of the group with haemodilution than of the group without (19 [86%] vs 6 [27%]). The two groups also showed significant differences in the total requirements of allogeneic packed red cells (haemodilution 9 units, no haemodilution 84 units) and fresh frozen plasma (9 vs 119 units). Although the haematocrit was slightly but significantly lower in the group who underwent haemodilution than in those who did not on postoperative days 1 and 8, the differences had disappeared by the second postoperative month. Postoperative complication rates, abnormal results in liver biochemical tests, and lengths of hospital stay were the same in patients with and without haemodilution. Intraoperative haemodilution in patients undergoing liver resection reduced requirements for all blood products, further lowering the risks associated with liver resection.

[Fractures of the trapezium. Mechanisms. Anatomo-pathology and therapeutic indications]. / Les fractures du trapèze. Mécanisme. Anatomo-pathologie et indications thérapeutiques.

Fractures of the trapezium are rare and often unrecognized lesions; their diagnosis can only be made by radiographs with specific projections that clearly separate the outline of the trapezium from the radial side of the carpal bony complex. Starting from a series of 88 cases collected from the world literature, 34 of which had been examined by the authors, a study was made of the different mechanisms of these fractures, their main fracture lines and displacements and the current indications for treatment. The physio-pathology of fractures of the trapezium was investigated by personal experiments conducted in the laboratory on 26 wrists and showed 3 main mechanisms: a fall on the hand with the wrist extended and radially deviated (Manon) and direct commissural trauma combined with various degrees of shearing described by Monsche. The fracture line is, in most cases, a vertical one and the lateral fragment which is connected to the first metacarpal is often subluxated proximally and radially. The treatment of these fractures can be conservative with immobilization in plaster either as the fracture lies or after reduction, or by continuous traction after reduction, or it can be operative. Direct internal fixation, completed, if necessary, by a stabilization of the thumb column using one of the various implants available today for the fixation of small fragments, should particularly be used for displaced and unstable fractures. Partial removal of the trapezium should be reserved for small fracture fragments that do not affect the joint surface or affect it very little. Proper treatment of this rare fracture is a key condition for the future function of the thumb column.

[Aneurysmal cyst of the clavicle : an uncommon lesion and a difficult diagnosis (author's transl)]. / Le kyste anévrismal de la clavicule. Une lésion rare. Un diagnostic difficile.

The authors describe a case of anevrysmal cyst of the clavicle seen in a five-year-old girl. Both clinical and radiological diagnosis proved impossible. Complementary investigations did not settle the question. surgical excision was decided on. In spite of an unfavorable macroscopic aspect, histological examination determined the nature of the tumor. The authors emphasize the great value of resorting to all branches of medical investigation when dealing with bone tumors. Before affirming a good prognosis, or, on the opposite, suggesting extensive and mutilating surgery, the utmost caution is required.

[Bacteriophage therapy of septic complications of orthopaedic surgery (author's transl]. / Bactériophages et chirurgie orthopédique. A propos de sept cas.

Seven septic cases have been treated by bacteriophage; two infections after insertion of a hip prosthesis, two septic arthritis of the knee, one osteomyelitis of the tibia, one septic non-union of the femur and one septic complication following Harrington rodding. Only specific phages were used in association with several types of surgical procedure. The technique of treatment is described. All cases were long-term infections with resistant organisms. Results were good in five, fair in one and one case was a failure. It is concluded that phage therapy may be helpful in the treatment of long-term infections.

[Arthroplasty of the hip by cemented coupled cups. A new technique (author's transl)]. / Arthroplastie de la hanche par cupules couplées cimentées.

A presentation of a technique of arthroplasty using cemented coupled cups which has been used in 50 cas over a period of more than a year. The hip is approached via an anterolateral incision with the patient in a dorsal horizontal position. This cemented cup arthroplasty has all the advantages of a classical total prosthesis: solid fixation, minimal rubbing by the use of a metal head and an acetabulum in high density polyethylene. However, it has none of the disadvantages since little cement is used, the medullary cavity is not opened and, above all, the neck of the femur is preserved, thereby rendering possible any later operation which may be necessary. The technique is described in detail and the indications rapidly reviewed.

[Cylindrical osteotomy of the upper end of the tibia [author's transl)]. / L'ostéotomie semi-cylindrique de l'extrémité supérieure du tibia. Réalisation par une technique originale.

The authors describe a modification of the original technique of Blaimont and Maquet. Cylindrical osteotomy allows correction of deformity in the frontal plane (genu varum or valgum) with forward displacement of the tibial tuberosity. The technique and instruments are described. The osteotomy is fixed by screws and joint mobilisation is begun after two weeks. Thirty patients have been operated on. The results are described as satisfactory.

[Reflections concerning the radiological assessment of static flat foot in the child (author's transl)]. / Réflexions à propos du bilan radiographique dans le pied plat statique de l'enfant.

After a precise review of the numerous parameters studied classically in AP and lateral films of the feet under load, the authors emphasis 5 measurements which are easy to determine and which they feel to objectively cover all the deformities which may be found in the static flat foot. These are: Talo-calcaneal divergence in AP and lateral views, the angle between the calcaneum and the floor, the lateral cavitation index and, finally, the angle of the axis of the talus and of the 2nd metatarsal in AP. A score of 20 is attributed to each. A score of 0 to 20 is attributed to each of these points, with a possible total, therefore, of 100. A study of 119 cases of flat foot in the child treated surgically over a period of 6 years made it possible to draw the distinction between the severe flat foot requiring operation and with a total of less than 45 points, and flat foot requiring medical orthopaedic treatment only (more than 45), the score for the normal foot being of the order of 90 points. This radiological study also makes it possible to distinguish, amongst flat feet in children, straight flat foot with collapse of the medial arch but no valgus of the forefoot and valgus flat foot where there is pronation of the calcaneum and abduction of the forefoot. This distinction is important since it determines the choice of operation. Thus in a case of valgus flat foot Judet's so-called "horseman" operation is indicated whilst in a flat foot without valgus, transposition of the tibialis anterior is preferable. In many cases, the lesion is mixed and both surgical gestures are required.

[Rupture of the rotator tendon]. / Les ruptures de la coiffe des rotateurs.

The authors report 25 cases of rupture of the rotator tendons operated on at the Stephanie Hospital in Strasburg, and discuss the surgical indications. Debeyre's technic was used with satisfactory overall results both on pain and function.

[A rare complication of the acetabulum: incarceration of a small intestine loop in the fracture area]. / Une complication rare des fractures du cotyle: L'incarcération d'une anse grêle dans le foyer de fracture

The authors report an exceptional case of fracture of the acetabulum complicated by tear of the small intestine due to injury to the loop of intestine by a piece of the fractured acetabulum. As it is rare, such a complication is often undiagnosed. Discovered in time, an operation avoids a fatal issue due to peritonitis.