Massive rotator cuff tears in patients younger than 65 years. Epidemiology and characteristics.

Currently, there is little information on the clinical, radiographic and electric profile of patients younger than 65 years of age with large rotator cuff tear. According to our hypothesis, massive rotator cuff tear, when discovered after recent traumatism, do not provide typical radiographic findings and suprascapular nerve impairment in large rotator cuff tears is uncommon. This is a prospective, descriptive, multicenter study of a series of 112 patients younger than 65 years, including 66 males and 46 females with extensive or massive cuff tear. Duration of symptoms was less than 6 months in 28 cases and secondary to trauma in 57 cases. Patients had loss of elevation or external rotation or both in 57 cases. An electromyogram (EMG) of suprascapular nerve was performed in 50 cases. A higher incidence of advanced fatty infiltration of the infraspinatus muscle (>stage 2 according to Goutallier) was observed in case of long-term symptomatology or in the absence of known trauma. Traumatic status was commonly found in patients with functional deficit in shoulder elevation, thus reporting a significantly lower Constant score (p<0.0001). Patients with both loss of shoulder elevation and external rotation had a significantly narrower subacromial space (5 mm versus 7.2 mm). No significant relationship could be established between electric impairment and massive cuff tear. According to the present study, in case of traumatic context and recent symptomatology, subacromial height and fatty infiltration of the infraspinatus muscle are better prognostic factors despite a pseudoparalytic shoulder. Repair should thus be considered. Moreover, the interest of a preoperative suprascapular nerve EMG is questionable.

[Acute closed injuries of the digital proximal interphalangeal joints]. / Les traumatismes fermé récents des IPP des doigts.

Acute closed injuries of the digital proximal interphalangeal (PIP) joints are frequent and can leave sequelae because of imprecise diagnosis of the lesions, poorly adapted treatment, or insufficient follow-up. The therapeutic options proposed in this presentation are advocated by all of the participants and are based on their personal experience and evidence reported in the literature. After a brief anatomic review necessary for the understanding of PIP joint pathophysiology we have presented the longterm outcomes of PIP joint injuries, which are central to the therapeutic decision-making process in terms of risk benefit ratio. To facilitate the presentation, we have separated lesions "with" and "without" fracture. A specific chapter is devoted to surgical approaches essential for successful management of these injuries and another to particular problems related to the seldom reviewed topic of traumatic injury of the PIP joint during bone growth.

[Results of a five-year series of 44 trapeziectomies associated with ligamentoplasty and interposition arthroplasty]. / Résultats à plus de cinq ans d'une série consécutive de 44 trapézectomies avec ligamentoplastie et interposition.

BACKGROUND: Surgical management of trapeziometacarpal joint osteoarthritis remains controversial. There have been few long term studies of trapeziectomy combined with ligamentoplasty and interposition arthroplasty (TLIA). Our results are based on a five year minimum follow-up study. METHODS: We carried out a study of 44 TLIA in 39 consecutive patients. A physical and radiological assessment was undertaken after on average of 6.9 years by a independent observer. RESULTS: A durable physical improvement was obtained in 18 cases in less than six months and in five cases after more than one year. Thereafter there was no secondary deterioration. A standard pain measurement gave an average result of 1.4 on a ten point scale. Pain was independent of displacement of the first metacarpal bone but had a tendency to be greater where associated with scaphotrapezoidal joint osteoarthritis. Strength was improved in 36 cases. The patients were satisfied and considered their grip to be normal in 41 cases. These variables did not change over time. DISCUSSION: TLIA give an excellent result in more than 90% of cases. This remains unchanged seven years after surgery. As opposed to prostheses, there is no secondary deterioration once healing is achieved. Algodystrophy is the main drawback. CONCLUSION: In our opinion, TLIA remains the best available surgical treatment of trapeziometacarpal joint osteoarthristis.

Aroma compound production in cheese curd by coculturing with selected yeast and bacteria.

The microorganisms involved in cheese ripening produce various volatile compounds and induce typical flavors that contribute to cheese variety. To investigate aroma compound generation of cheese microflora, we used a dynamic headspace-gas chromatography-mass spectrometry analysis. To obtain good sensitivity and repeatability of quantification, dynamic headspace conditions and sample preparation were first optimized and led to an extraction set up in which samples were heated at 60 degrees C and diluted with water without pH adjustment. Then three different yeasts and three Geotrichum candidum commonly used in mold surface ripened cheeses were studied in pure culture in a cheese model medium. Thirty-nine cocultures of these three yeasts, the three G. candidum, and five bacteria were studied in the same medium to assess the interaction between microorganisms on aroma compound production. Twenty-four volatile compounds belonging to different chemical classes (alcohols, aldehydes, esters, sulfides, terpenes) were identified and quantified. Yeasts and especially Kluyveromyces lactis produced large amounts of alcohols, aldehydes, esters, and terpenes when cultured alone or in association. Geotrichum candidum and especially G. candidum strain G3 generated the largest amount of sulfides when cultured alone or in association. Finally, bacteria also produced aroma compounds but, except for Brevibacterium linens strain B5, which produced dimethyl trisulfide and ketones, no specific trend in the production of particular aroma compounds could be evidenced.