[Investigation and analysis of an outbreak of cutaneous leishmaniasis in Ksar Ouled Dabbab, Tataouine (Tunisia), 2012-2013]. / Investigation et analyse d'une épidémie de leishmaniose cutanée à Ksar Ouled Dabbab, Tataouine (Tunisie), 2012-2013.

UNLABELLED: Zoonotic cutaneous leishmaniasis (ZCL), due to Leishmania major, and chronic CL, due to L. tropica, are endemic in the governorate (administrative subdivision) of Tataouine (southeast Tunisia). This study aims to analyze epidemiologic, clinical, parasitologic, and entomologic data collected during the 2012-2013 epidemic in Ksar Ouled Dabbab (KOD). METHODS: The KOD health care center diagnosed 164 CL cases from July 2012 to March 2013, identifying 21 Leishmania isolates and local sandflies. RESULTS: The incidence rate of CL in KOD was around 27.5/1000 inhabitants. The age groups most strongly affected were children younger than 10 years (19.9%) and those aged 10-20 years (23.1%). The number of patients with multiple lesions (67.9%) and their location on limbs (71.3%) indicated ZCL. This hypothesis is supported by the high proportions of L. major (81%) and Phlebotomus papatasi found. CONCLUSION: The epidemiologic and clinical profiles of the cases and the predominance of L. major and P. papatasi confirm that the recent outbreak in KOD was related to ZCL. It probably followed recent environmental changes and transmission spread from adjacent neighboring foci.

[Intracarpal revascularization arthrodesis with transposition of the capitate bone (Graner type II)]. / Arthrodèse intracarpienne de revascularisation avec transposition du grand os (Graner type II).

Necrosis of the lunate requires surgery when it is painful and disabling. Decoulx's stage III is too often beyond reconstructive surgery (lengthening of the ulna, shortening of the radius), while such disabling procedures as wrist arthrodesis are not indicated yet. The intracarpal revascularizing arthrodesis with transposition of the capitate (described by Graner in 1966) is to be considered at this stage. The creation of a new condylar arch coated with cartilage, resembling the physiologic arch, and the preservation of the radio-carpal mobility, allows the return of sufficient motion and strength for everyday needs. The wrist often gets painfree; this procedure should thus be considered as a palliative salvage operation, none the less useful in young manual workers.

[The Ender nailing : state of the art and new improvements. The sliding nailing (author's transl)]. / L'enclouage selon Ender : bilan at améliorations techniques. Le verrouillage coulissant.

The authors, as well as many other people, have encountered some misuses and complications of Ender nailing. Some surgical improvements are pointed out : reduction with a slight valgus, meticulous digging of the hole, sagital precurving of the nails, careful selection of loading criteria. A new device is also described from the Ender nail, that they modified : an Ender nail with a distal screwing slide which allows distal screwing and therefore prevents going down and rotation of the nails. A case study of three comparative series showed the substantial progress which was made possible by these technical improvements, and most of all by the distal sliding screwing.