Short medial approach harvesting of hamstring tendons.

Harvesting the hamstring tendons for anterior cruciate ligament reconstruction is not straightforward to perform or to teach: the incision is small, the work-space is narrow and the surgeon's tactile feedback using the stripper is difficult to explain to juniors. The purpose of this short note is to describe a reliable means of harvesting the semitendinosus, gracilis or both. Patient and tourniquet positioning, instrumentation and landmarks are detailed; then the 6 steps (speed-bump 1, speed-bump 2, bubble, hook, expansions, stripper) are explained.

[Combined tibio-talar and subtalar arthrodesis by retrograde nail in hindfoot rheumatoid arthritis]. / Arthrodèse combinée tibio-talienne et sous-talienne par clou transplantaire dans l'arrière pied rhumatoïde.

PURPOSE OF THE STUDY: Many techniques for ankle arthrodesis have been described. Some are not applicable to patients with severe rheumatoid arthritis (RA) because of osteopenia and deformities. This study describes a new surgical technique for arthrodesis in painful valgus deformity of the hind-foot in advanced rheumatoid arthritis (RA) with severe osteopenia. MATERIALS: The present series included 9 patients. Eleven talocrural and talocalcaneal arthrodeses were performed for degenerative changes secondary to RA involving hind-foot joints. All patients were reviewed after an average follow-up of 6 years. Mean duration of RA was 34 years. All patients had severe osteopenia, including major deformations of the hind-foot in 5 cases. METHODS: After removal of talocrural and talocalcaneal articular surfaces using an anterolateral approach, deformities were corrected by removal of an appropriate bone wedge. A Küntscher nail was then positioned in the calcaneal plantar cortical through the plantar surface of the foot and driven proximally into the medullary canal of the tibia through the talus. This nail allowed both deformity correction and fixation. Aftercare required immobilization in a short leg cast. Weight bearing was allowed with the cast approximately 5 weeks after surgery. The ankle was immobilized for 7.5 weeks. DISCUSSION: Results showed a 80 per cent fusion rate. Two non-unions occurred (one recurrence of valgus deformity after early nail migration requiring removal of the nail; and the other asymptomatic). A complication occurred in one foot (delayed healing). At follow-up, all patients but one were satisfied with respect to pain relief and residual deformities. Our results are comparable with those of other series and should be considered in the context of severe RA. CONCLUSION: This technique of vertical retrograde transarticular nailing allows an easy control of hind-foot deformities correction. Other techniques are preferable in case of solid bone. This technique is an acceptable alternative in advanced RA.

[An experimental short-term study of intramuscular integration of macroporous biphasic calcium phosphate ceramics. Application to the achievement of biocomposite flaps]. / Etude expérimentale à court terme de la réhabitation en site intra-musculaire d'une céramique de phosphate de calcium bi-phasée macroporeuse. Application à la réalisation de lambeaux biocomposites.

The aim of this research is to prefabricate a bicomposite flap, which can be defined as a composite structure of foreign material and living tissue. An animal model was developed by vascularizing spherical implants of macroporous biphasic calcium phosphate by a latissimus dorsi muscle flap in rabbits. The experiment was divided into three stages to compare the role of blood flow in the flap and autologous marrow bone cells. Biological apatite precipitation inside the macropores requires both factors and allows further clinical applications.

[Textiloma. Apropos of 25 cases and review of the literature]. / Textilomes. A propos de 25 cas et revue de la littérature.

It is exceptional to "forget" a compress in a operative wound, but the consequence are important. We report 25 cases of textilomes operated over a period of 18 years. There were 18 cases involving visceral surgery and 7 involving bone surgery. Sixty percent of the patients were women and 82% were adults. Emergency surgery was required in 70% of the bone operations and in only 33% of the visceral indications. Twelve percent of the cases were discovered fortuitously and 40% led to pain or occlusion, 24% leading to a digestive tract fistula and 24% to an inflammatory tumour formation. Standard X-rays and echography were sufficient for diagnosis in the abdominal cases. CT scan or MRI may be useful. Ablation of the abdominal foreign body was the followed by complications in two-thirds of the cases with a mortality of 25%. No deaths were observed in the other localizations but the functional result was impaired. We reviewed the literature reporting 117 such cases.

[Bilateral renal malacoplakia. Apropos of a case]. / Malacoplakie à localisation bilatérale rénale. A propos d'un cas.

The authors report a very rare case of malacoplakia affecting both the bladder and the upper urinary tract bilaterally. Attempts at treatment failed and autopsy confirmed the existence of pseudo-tumoral malacoplakia of the kidneys and urinary tract with multiple lymph node sites and pulmonary involvement. This is followed by a review of the literature and a pathogenic study.

[Problems of cystic uretero-pyelitis (author's transl)]. / Problèmes posés par la pyélo-uré,érite kystique.

The authors report on a series of 7 new cases of cystic uretero-pyelitis (C.U.P.). An historical and pathogenic review of this anatamo-radiologic entity is presented. The conditions for discovery were: renal colic in 4 instances, discovery during surgery in association with a pyeo-ureteral junction syndrome in one instance, and a hematuria in three instances (1 being accompanied by renal colic). Age varied from 22 to 78 years, with an average age of 61 years. The distribution between the sexes was equal: 4 women and 3 men. Urinary infection was observed in cases (colibacilluria), whereas it was absent in 3 cases. If hematuria is present, one should, as a rule, look for a possible association with an ureteral or vesical tumor (1 case). The final diagnosis can be established only through histological examination (this was the case in only 3 of our patients), but when there is a suggestive radiologic image and a reassuring clinical picture, one can recommend a simple medical treatment (1 recovery) and propose a steady radiologic surveillance. In case of doubt or hematuria, it is preferable to advocate surgical investigation: 2 patients out of the 3 showing a hematuria, were operated on, the third having refused. In one case, hematuria was due only to cystic uretero-pyelitis, while the second was known to have a vesical tumor with C.U.P. The real danger, in presuming a cystic uretero-pyelitis, is the failure to recognize a ureteral papillomatosis, hence the necessity of radiologic surveillance. The authors did not note any serious bilateral form. The only bilateral involvement seen in the 7 cases was not accompanied by reanl deficiency.