[Socio-professional evaluation of 184 patients with hand injuries treated at an emergency microsurgery service]. / Bilan socio-professionnel de 184 accidentés de la main traités en service de microchirurgie d'urgence.

184 consecutive patients were operated for severe industrial injuries of the hand. Microsurgical techniques were used in 86% of cases, with 41% of replantation (with about 1/3 of failures), and revascularization, and 17% of sutures of median and ulnar nerves. These patients were examined by medical experts from the French National Health Service, independently of their surgeons, in order to determine under which conditions they could resume their professional activities (changes of their working conditions or not, reduction in their wages or not, etc.). Moreover the duration of work interruption, as well as the percentage of professional disabilities, were known for more than 90% of the 115 patients who underwent an official assessment. The average percentage of professional disability was 19%, whereas without specialized surgery it used to be roughly 30 to 40% for the same lesions. The value of microsurgical techniques was obvious when considering the ability of the patients to resume their previous activities, especially as 96% of them were manual workers. Only 12% of the patients did not resume their work (5% were unemployed, and 7% retired or were too disabled to work). 18% were able to return to work, but with modifications of their working conditions or their wages. But, most important, 70% of the patients resumed their previous work with the same pay. On average, they had to stay for ten days in the surgical department and had to stop work for 3 months. This may be due to our great concern with early rehabilitation, aimed at manual work, with early transfer of patients to specialized rehabilitation centers.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of ketoprofen and pethidine in severe postoperative pain]. / Etude comparative du kétoprofène et de la péthidine dans les douleurs postopératoires sévères.

A double-blind study was conducted to compare the efficacies of a non steroid antiinflammatory drug (ketoprofen) and a central analgesic drug (pethidine). The series included 59 patients who had undergone especially painful joint surgery (knee arthrolysis and ligamentoplasty, carpal or foot surgery). Main pain relief as assessed by the patients was the same in both groups (67% with ketoprofen or 63% with pethidine). It lasted the same length of time in both groups: 9.2 h with ketoprofen and 8 h with pethidine. An identical efficacy was observed in the most painful surgery, i.e. arthrolysis (efficacy 57% for a period of 8 h in both groups), as well as in the better tolerated procedure, i.e. carpal surgery; in this case, however, the pain relief seemed to last longer with the ketoprofen (10 h) than with the pethidine (8 h). Ketoprofen probably acts more through its central analgesic effect than its antiinflammatory effect. It has few side-effects. It does not have the risks of respiratory depression or tolerance unlike the opiate drugs. This drug could therefore be interesting in elderly patients and in surgical procedures where the active participation of patients is required for early rehabilitation, e.g. joint mobilization.

[Weight-bearing early after osteosynthesis of the femoral neck by nail-plate (100 cases)]. / Appui précoce après ostéosynthèse du col fémoral par vis plaque (100 cas).

One hundred trochanteric or transcervical fractures, 64 of which were in patients more than 75 years old, were treated by internal fixation with a THS nail-plate. This device is characterised by a better bending strength than a one-piece nail-plate and a design which limits the risk of displacement of the screw in the head so that immediate weight-bearing can be allowed. Weight was borne on the limb in 81 cases at the tenth post-operative day. It did not improve the mortality, there being 17 deaths by the third month but it greatly helped post-operative care and rehabilitation without producing any additional complications. As a result, 43 per cent of patients could return home by the 45th post-operative day and 74 per cent had recovered their previous level of autonomy within three months of operation. There were only four mechanical complications, all in transcervical fractures: one crack fracture in the femoral head and three displacements following inadequate reduction, treated by prosthetic replacement. The follow-up of 80 patients at three months showed that consolidation always developed between the 45th and 90th day with full weight-bearing and a stable radiological picture. There was no intra-articular penetration or bending of the screw and no break-out of the implant. Whilst it is a definite advance in the treatment of trochanteric fractures, a longer follow-up is needed to determine its place compared with prostheses in transcervical fractures.

Ultrasonographic anatomy and diagnosis of fetal uropathies affecting the upper urinary tract. II. Nonobstructive uropathies.

The authors describe the ultrasonographic anatomy and semiology of allowing detection of the main types of fetal non-obstructive uropathies. The results of the author's personal experience in this domain are compared to data from the literature. Differential features of the uropathies are given and the limitations and practical significance of prenatal and postnatal ultrasonography are discussed.

Ultrasonographic anatomy and diagnosis of fetal uropathies affecting the upper urinary tract. I. Obstructive uropathies.

The authors describe the ultrasonographic anatomy and semiology of allowing detection of the main types of fetal uropathies. The results of the author's personal experience in this domain are compared to data from the literature. Differential features of the uropathies are given and the limitations and practical significance of prenatal and postnatal ultrasonography are discussed.

[Ventricular branches of the circumflex artery of the heart]. / Les branches ventriculaires de l'artère circonflexe du coeur.

Because of the great number of anatomic descriptions, and because of the variability of the nomenclature, the authors realized three studies: anatomical, radiological, and surgical studies of 198 hearts (150 dissections and 148 angiographies). There are 3 groups of collateral branches for the left ventricle: --The lateral branch (existing in 49 per cent of the cases), beginning after a short space with often an intra-myocardial segment, and running obliquely on the pulmonary surface of the left ventricle. --The lateral and inferior branch (existing in 38 per cent of the cases), situated just between the pulmonary and diaphragmatic surface of the ventricle, and perpendicular to the coronary sulcus. --The inferior or posterior branches (existing in 59 per cent of the cases), which are parallel to the inferior (or posterior) interventricular sulcus, on the diaphragmatic surface of the heart.