[Thigh and leg musculo-cutaneous island flap for giant bilateral trochanteric and perineal pressure sores coverage: Extreme treatment in spinal cord injury]. / Lambeau musculo-cutané total de cuisse et de jambe en îlot en couverture d'une escarre trochantéro-périnéale géante : solution extrême chez le blessé médullaire.

INTRODUCTION: Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores. PATIENT AND METHOD: A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left trochanteric pressure sore. RESULT: The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks. DISCUSSION: A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning).

[Financial rating optimization in pressure ulcers management: yes, but at what price?]. / Optimisation de la cotation dans la prise en charge des escarres: oui, mais à quel prix ?

The surgical management of pressure ulcers remains very expensive even if preventive measures and improved care pathways allowed to reduce spending in this domain in recent years. Since 2004, the funding of French hospitals by "fee-for-service" and the needs of saving health spending necessarily compels us to interest ourselves in these purely economic considerations and sometimes modify our requirements for hospital stay to optimize a "patient' valorisation group". In the future, this may lead the surgeon to bias the real needs of the patient for the benefit of hospital establishment. Through a medico-economic analysis of our practices conducted in the plastic surgery department of the University hospital of Toulouse, we tried to identify how to optimize the surgical management of pressure ulcers in terms of valorisation of hospital stay. The aim is still to remain critical about the aberrations that this could introduce in the future for our clinical activity.

Contributions of natural arsenic sources to surface waters on a high grade arsenic-geochemical anomaly (French Massif Central).

The subwatershed studied drains a non-exploited area of the St-Yrieix-la-Perche gold mining district (French Massif Central) and it is located on an arsenic (As) geochemical anomaly. In this context, it is important to know the geochemical processes involved in the transfer of As from solid environmental compartments to the aquatic system. The stream showed a temporal variation of dissolved As (As(d)) content from 69.4 µg.L(-1) in the low flow period to 7.5 µg.L(-1) in the high flow period. Upstream, ground- and wetland waters had As(d) concentrations up to 215 and 169 µg.L(-1), respectively. The main representative As sources were determined at the subwatershed scale with in-situ monitoring of major and trace element contents in different waters and single extraction experiments. The As sources to stream water could be regrouped into two components: (i) one As-rich group (mainly in the low flow period) with groundwater, gallery exploration outlet waters and wetland waters, and (ii) one As-poor group (mainly in the high flow period) with rainwaters and soil solutions. In the soil profile, As(d) showed a significant decrease from 52.4 µg.L(-1) in the 0-5 cm superficial soil horizon to 14.4 µg.L(-1) in the 135-165 cm deep soil horizon. This decrease may be related to pedogenic processes and suggests an evolution of As-bearing phase stability through the soil profile. Quantification of As(d) fluxes at the subwatershed scale showed that groundwater was the major input (>80%) of As(d) to surface water. Moreover, natural weathering of the As-rich solid phases showed an impact on the As release, mainly from superficial soil horizons with runoff contributing about 5% to As input in surface water.

[Outcome at 18 months after the recall of Poly Implant Prosthesis. Experience of a cancer center]. / Bilan à 18 mois du retrait du marché des prothèses Poly Implant Prothèse. Expérience d'un centre anticancéreux.

INTRODUCTION: On March 30, 2010, AFSSAPS (sanitary French) issued a medical alert about breast implants "Poly Implant Prothese" (PIP), because it was shown that its failure rate was higher than of other manufacturers. This alert was accompanied by a suspension of sales and use of breast implants PIP. Since the announcement of this decision, the Institut Claudius Regaud (ICR) has set up a crisis unit to best meet the demands and questions concerning patients who had PIP implants. After 18 months of the beginning of the crisis, we decided to review the consequences of this decision. PATIENTS AND METHODS: This is a retrospective study of all patients who underwent breast reconstruction with a prosthesis PIP since 2006. We are interested in managing of the crisis, the fate of patients and the problems of implants. RESULTS: In total 128 PIP prostheses were implanted on 116 patients. These were all cases of asymmetric anatomic implants placed in 91 cases in immediate breast reconstruction and of breast-delayed reconstruction in 25 cases. Twelve patients had a contralateral PIP prosthesis. After careful analysis of the records, we found that 18 patients (16%) had received a change of prosthesis or simple removal of the prosthesis before the beginning of the crisis. No prosthesis was broken. After the retrospective chart review we found that we reoperated 61,2% of patients and explanted 59,4% of prostheses PIP. In 31 cases (26,7%), another surgery was associated with the change of prosthesis. Of the 76 explanted prostheses, ten of them had an abnormality (13,1%). Three implants (3,9%) were ripted. Six implants (7,9%) had a phenomenon of perspiration. The average life span of these prostheses was of 21,3 months. Among patients who were reoperated, we observed three postoperative complications (3,9%). CONCLUSION: More than 18 months after the withdrawal on the market of breast implants PIP, we reviewed almost all patients implanted at our institution. To date, 60% of patients no longer have this prosthesis in place, but 16% of patients with this specific breast implant had already been remove before March 2010. Eighteen percent of implants had an abnormality and three had a rupture. In this retrospective study we also found that the care of our patients could be improved, including the legibility of the monitoring and in the administrative field.

[Macrolane®: A severe case of calf cellulitis after modeling injection]. / Macrolane® : un cas grave de cellulite du mollet après injection modelante.

In recent years, the market for resorbable injectables has been steadily expanding. The European Community's seal of approval (CE) is a sufficient guaranty to get them distributed. These injectables do not require official approval because they are considered to be "implantable medical devices" and not medicines. Macrolane(®)is a hyaluronic acid in gel form (NASHA [non-animal stabilized hyaluronic acid]) and has been on the French market since 2007. It can be injected into all areas except the face. It is highly cross-linked which, while slowing its absorption into the body, can also leave long-lasting residues. We report the first case of cellulitis after injection into the calf by a practitioner in his office.

Mobility and potential toxicity of sediment-bound metals in a tidal estuary.

Sediment toxicity in the Gironde Estuary, France, a site contaminated by such trace metals as Cd, Cu, and Zn, was examined monthly from March to October 1997, using concurrently geochemical procedures to assess the mobility of contaminants and ecotoxicity tests with invertebrate larvae (the oyster Crassostrea gigas, the sea urchin Paracentrotus lividus, and the copepod Tigriopus brevicornis). Higher mobility of Cd than of Cu and Zn was shown by desorption tests. Both the gross concentrations of Cu and Zn in the sediment and the mobility of these metals showed a temporal evolution, and changes in the toxicity of the sediment to invertebrate larvae generally were observed concomitantly. Little damage was registered in the spring, and greater damage was found in the summer and fall. Positive correlations were shown between mortality in copepods or abnormalities in oyster larvae with the quantities of metals remobilized from sediment at pH 4. On the contrary, no clear temporal trend was shown for total PAH levels in sediment. These correlations and previous toxicological data suggest that sediment-bound metals, particularly Cu and Zn, possibly play a role in biological responses.

Adsorption of arsenic (V) on kaolinite and on kaolinite-humic acid complexes. Role of humic acid nitrogen groups.

In order to investigate the influence of organic matter on arsenic retention, we used batch experiments at pH 7 to determine the adsorption of As(V) on three different solids: a crude, purified, Ca-exchanged kaolinite and two kaolinites coated with humic acids (HAs) having different nitrogen contents. We first examined the adsorption of each HA onto kaolinite, and then used the HA-kaolinite complexes to study As(V) adsorption. The results clearly show an influence of the HA coating on As adsorption. For example, with low initial As concentrations the solid/liquid partition coefficient (R(d)) for both HA complexes is greater than that for the crude kaolinite. We found that increasing the initial As concentrations decreased the R(d) values of the HA-coated kaolinites until finally they were the same as the crude kaolinite R(d) values. This suggests that adsorption occurs first on the HA sites and then, once the HA sites are saturated, on the remaining kaolinite sites. We also noted that the more reactive HA-kaolinite complex was the one with the highest N/C ratio. Comparing the amount of amine groups in the HA-kaolinite complexes with the total amount of adsorbed As indicates that the HA amine groups, due to their positive charge at pH 7, play a key role in the adsorption of As onto organic matter.

An arsenic(III)-oxidizing bacterial population: selection, characterization, and performance in reactors.

AIMS: To select an autotrophic arsenic(III)-oxidizing population, named CASO1, and to evaluate the performance of the selected bacteria in reactors. METHODS AND RESULTS: An As(III)-containing medium without organic substrate was used to select CASO1 from a mining environment. As(III) oxidation was studied under batch and continuous conditions. The main organisms present in CASO1 were identified with molecular biology tools. CASO1 exhibited significant As(III)-oxidizing activity between pH 3 and 8. The optimum temperature was 25 degrees C. As(III) oxidation was still observed in the presence of 1000 mg l(-1) As(III). In continuous culture mode, the As(III) oxidation rate reached 160 mg l(-1) h(-1). The CASO1 consortium contains at least two organisms - strain b3, which is phylogenetically close to Ralstonia picketii, and strain b6, which is related to the genus Thiomonas. The divergence in 16S rDNA sequences between b6 and the closest related organism was 5.9%, suggesting that b6 may be a new species. CONCLUSIONS: High As(III)-oxidizing activity can be obtained without organic nutrient supply, using a bacterial population from a mining environment. SIGNIFICANCE AND IMPACT OF THE STUDY: The biological oxidation of arsenite by the CASO1 population is of particular interest for decontamination of arsenic-contaminated waste or groundwater.

Anatomy of the arterial vascularization of the lips.

The findings from 12 dissections of previously injected facial masks, 8 dissections of the face following intraarterial injection of a red solution of Latex Neoprene, and a corrosion cast specimen allowed us to study the arterial supply of the lips. The arterial supply of the upper lip arises mainly from the superior labial arteries, but also from the subseptal arteries and from the subalar arteries. There is a figure of 8 shaped anastomotic system between these arteries lying on the upper lip. The arterial supply of the lower lip arises from the inferior labial arteries and from branches of the mental artery. A constant inferior labial arterial network was shown at the level of the lower lip arising in a fifth of cases from a T-shaped inferior labial artery. All these recent anatomic findings help us to improve our understanding of plastic surgery of the lips.

[Treatment of the sequelae of enucleation by septal chondro-mucosal composite graft. Report of 21 cases]. / Traitement des séquelles d'énucléation par greffe composée chondro-muqueuse septale. A propos de 21 cas.

Enucleation frequently and progressively causes an enophtalmus and atrophia of the inferior eyelid, thereby leading to a height deficiency. Buccal mucous grafts give rise to phenomena such as secondary retraction. This may have complex and painful post-operative outcomes. However, when a septal chondromucous graft is performed, the height in the inferior palpebral part becomes more aesthetic, more retentive and quickly allows the wearing of a more voluminous prosthesis. Thus, the notinable enophtalmus can be corrected and the aesthetic quality of the looking is substantially restored. The authors report this surgical procedure and the results obtained with 21 patients which appear to be particularly promising.