[Floating elbows: anatomo-clinical aspect and review of treatment method]. / Coudes flottants: aspects anatomocliniques et l'analyse du traitement.

INTRODUCTION: Floating elbows are rare pathologies that cause a number of problems to manage. The current treatment tendency is surgical. The orthopedic treatment is a good management option when the technical plateau is limited. METHODS: We performed an 18-month prospective study that included patients with floating elbows. Two treatment methods were used and chosen following predefined indication criteria. The final evaluation was made on average 10 months (minimum 6 and maximum 18 months) according to the functional classification of the mayo clinic. RESULTS: In 18 months, we treated 8 patients with floating elbow, who were all victims of traffic accidents. On an anatomo-clinical level, real floating elbows accounted for 37.5% of all cases, the rest were derived pathologies. Among these derived pathologies, the association of diaphyseal fracture of the humerus with a lesion of one or both forearm bones represented 50% of the cases. Regarding skin condition, open fractures were present in 37.5% of all patients. At the final evaluation we obtained two unsatisfactory results in patient treated surgically. No orthopedic treatment achieved an excellent final result, but they ranged between good and fair. CONCLUSION: This study shows that the orthopedic treatment maintains its position as valid treatment for floating elbows. Nevertheless it is important to master the technique and recognize its limits.

INTRODUCTION: Les coudes flottants sont des pathologies rares qui posent assez de problèmes de prise en charge. La tendance actuelle du traitement est celle de la chirurgie mais le traitement orthopédique est un bon moyen quand on a un plateau technique limité. MATÉRIEL ET MÉTHODE: Nous avons fait une étude prospective de 18 mois qui consistait à faire la prise en charge des patients présentant des coudes flottants. Deux méthodes de traitement ont été utilisées avec des critères d'indication préalablement définis. L'évaluation définitive s'est faite en moyenne en 10 mois avec des extrêmes de 6 et 18 mois et selon la classification fonctionnelle de mayo clinic. RÉSULTATS: En 18 mois, nous avons traité 8 patients présentant des coudes flottants qui étaient tous des victimes d'accidents de circulation. Sur le plan anatomopathologique, les coudes flottants vrais représentaient 37,50% les autres étaient des dérivées. Parmi ces dérivées, l'association de la diaphyse humérale à l'un ou les deux os de l'avant bras représentait 50%. Par rapport à l'état cutané, 37,50% des patients avaient de fractures ouvertes au niveau de l'avant bras. A l'évaluation finale nous avons obtenu 2 mauvais résultats issus du traitement chirurgical, les autres étant des bons et moyens résultats. CONCLUSION: Cette étude montre à suffisance que le traitement orthopédique garde sa place dans le traitement des coudes flottants, mais il faut avoir la maitrise de la technique et connaître ses limites.

Dietary pectin and calcium inhibit colonic proliferation in vivo by differing mechanisms.

Diet plays an important role in promoting and/or preventing colon cancer; however, the effects of specific nutrients remain uncertain because of the difficulties in correlating epidemiological and basic observations. Transmissible murine colonic hyperplasia (TMCH) induced by Citrobacter rodentium, causes significant hyperproliferation and hyperplasia in the mouse distal colon and increases the risk of subsequent neoplasia. We have recently shown that TMCH is associated with an increased abundance of cellular beta-catenin and its nuclear translocation coupled with up-regulation of its downstream targets, c-myc and cyclin D1. In this study, we examined the effects of two putatively protective nutrients, calcium and soluble fibre pectin, on molecular events linked to proliferation in the colonic epithelium during TMCH. Dietary intervention incorporating changes in calcium [high (1.0%) and low (0.1%)] and alterations in fibre content (6% pectin and fibre-free) were compared with the standard AIN-93 diet (0.5% calcium, 5% cellulose), followed by histomorphometry and immunochemical assessment of potential oncogenes. Dietary interventions did not alter the time course of Citrobacter infection. Both 1.0% calcium and 6% pectin diet inhibited increases in proliferation and crypt length typically seen in TMCH. Neither the low calcium nor fibre-free diets had significant effect. Pectin diet blocked increases in cellular beta-catenin, cyclin D1 and c-myc levels associated with TMCH by 70%, whereas neither high nor low calcium diet had significant effect on these molecules. Diets supplemented with either calcium or pectin therefore, exert anti-proliferative effects in mouse distal colon involving different molecular pathways. TMCH is thus a diet-sensitive model for examining the effect of specific nutrients on molecular characteristics of the pre-neoplastic colonic epithelium.

Melanoma differentiation associated gene-7 (mda-7): a novel anti-tumor gene for cancer gene therapy.

BACKGROUND: The mda-7 gene (melanoma differentiation associated gene-7) is a novel tumor suppressor gene. The anti-proliferative activity of MDA-7 has been previously reported. In this report, we analyze the anti-tumor efficacy of Ad-mda7 in a broad spectrum of cancer lines. MATERIALS AND METHODS: Ad-mda7-transduced cancer or normal cell lines were assayed for cell proliferation (tritiated thymidine incorporation assay, Alamar blue assay, and trypan-blue exclusion assay), apoptosis (TUNEL, and Annexin V staining visualized by fluorescent microscopy or FACs analysis), and cell cycle regulation (Propidium Iodide staining and FACs analysis). RESULTS: Ad-mda7 treatment of tumor cells resulted in growth inhibition and apoptosis in a temporal and dose-dependent manner. The anti-tumor effects were independent of the genomic status of p53, RB, p16, ras, bax, and caspase 3 in these cells. In addition, normal cell lines did not show inhibition of proliferation or apoptotic response to Ad-mda7. Moreover, Ad-mda7-transduced cancer cells secreted a soluble form of MDA-7 protein. Thus, Ad-mda7 may represent a novel gene-therapeutic agent for the treatment of a variety of cancers. CONCLUSIONS: The potent and selective killing activity of Ad-mda7 in cancer cells but not in normal cells makes this vector a potential candidate for cancer gene therapy.