[Foreign body reaction in osteoarthrosis of the trapeziometacarpal joint treated with trapezectomy and interposition of a Dacron "anchovy". A series of 5 cases]. / Réaction à corps étranger dans les rhizarthroses traitées par trapézectomie et interposition d'un "anchois" en Dacron. A propos de cinq cas.

Osteoarthritis of the trapeziometacarpal joint is a common pathology. Numerous surgical procedures exist without any of one of them showing an obvious superiority. In our practice, when the trapezium is not big enough to allow use of a Roseland total joint arthroplasty, we used a combination of trapeziectomy and Dacron anchovy interposition. This simple and fast technique gives results similar to others in terms of pain, joint motion and strength. It appeared to be a safe technique until 2000, where an abnormal complication appeared: five implants (11% of the 46 used between 2000 and 2002) displayed a foreign body reaction both clinical and radiological, and three patients underwent revision surgery for ablation of the implant. Histological analysis confirmed this adverse reaction in all of the cases. In view of the delay between surgery and reaction we expect new cases to appear, thereby increasing the current rate. In view of the lack of any other explanation for these findings, the authors have stopped using the Dacron implant, and have instead reverted to a classical tendon interposition.

[Extensor digitorum muscle flap: its position in ankle and foot coverage. Report of 15 cases]. / Place actuelle du lambeau d'extensor digitorum brevis dans la reconstruction des pertes de substance de la cheville et du pied. A propos de 15 cas.

The authors report their experience about a 15 cases series of ankle and foot soft tissues defects reconstruction with the extensor digitorum brevis flap which demonstrates its advantages. The flap was elevated in 9 cases on the tibial artery while the 6 others were raised on the distal dorsalis pedis artery with a retrograde flow. Healing was obtained for all cases with a complete resolution of septic problems for the 8 concerned cases. The outcome was uneventful for all but one which presented with a partial skin donor site secondary necrosis. No functional or trophic problems were noticed in other cases. Elevation of the extensor digitorum brevis flap is simple without note-worthy sequelaes. It is a reliable technique either for skin coverage or osteitis cure at level of the ankle. When raised with a retrograde arterial flow, it also appears as a useful alternative for the fore-foot reconstruction, location recognized difficult to treat by local means.

[Acute carpal tunnel syndrome. A report of an etiological form not previously described]. / Syndrome du canal carpien aigu. A propos d'une forme étiologique non décrite.

Acute form of carpal tunnel syndrome is the less common presentation. Several etiologies are known as rheumatologic, hemopathic, endocrine or pregnant disorders and traumatic. Authors report a non yet described traumatic etiology, consecutive to hamate and triquetral fractures. Patient presented five hours after initial traumatism, a typical presentation of median nerve compression at wrist, with subjective and objective symptoms as pathologic Weber test. A classical median nerve release was performed in emergency. Nerve recuperation was complete two days after surgery, as usual in such pathology. This new etiology must be known; actually, nerve recuperation in acute carpal tunnel syndrome is time dependent.

[Laënnec, re-inventor of the stethoscope?]. / Laënnec, ré-inventeur du stéthoscope?

According to our common medical culture, some facts are simply unquestionable, for instance Laënnec invented the stethoscope. But was he the first one? On a recent trip to Egypt we visited the temple of Kom Ombo, built prior to the roman period and renowned as a medical care center. Today, the tourist is fascinated by the magnificent hieroglyphics on the well-preserved walls testifying to significant advances in various fields of medicine including ophthalmology and gynecology. We were particularly interested by the basreliefs presenting vivid drawings of some of the first medical instruments. We easily identified curettes, scissors, a balance, forceps for dental extraction, and a surgical saw, but were captivated by two other instruments. The first one looked a lot like what Laënnec invented around 1820. The second one was amazingly similar to the instrument we use everyday, with a distal opening and flexible tubes (woven papyrus?) leading to proximal ear pieces. Our Egyptian guide was formal: the stethoscope was invented in Egypt. The scientific impact of our observations leaves something to be desired, but did make us think about the huge gap between the advancement of medical knowledge in ancient Egypt and Laënnec's (re)-invention. Exposed to a similar gap in history, what would our documents stored on CD and video tapes have to say to future touring doctors?