Long-term results of heart transplant in recipients older and younger than 65 years: a comparative study of mortality, rejections, and neoplasia in a cohort of 445 patients.

BACKGROUND: Whether being older than 65 years should be considered an absolute counterindication to heart transplant (HT), as it is in some centers, is controversial. In our centre, patients older than 65 years are accepted for HT if they satisfy stringent conditions. The aim of this study was to examine whether heart recipients older than 65 years have a greater risk of rejection, neoplasia, or mortality than younger ones. METHODS: We studied 445 patients who underwent HT between April 1991 and December 2003, 42 of whom were older than 65 years and 403 who were 65 years or younger. The parameters evaluated were the cumulative incidences of neoplasias and rejections (ISHLT grade > or = 3A), and the survival rates 1 month, 1 year, and 5 years post-HT. RESULTS: The two groups had similar percentages of patients with at least one rejection episode (< or =65 years 56.9%, >65 years 51.3%; P > .05), and although there were proportionally almost twice as many tumors in the older group (14.2%) as in the younger (7.9%), this difference was not statistically significant either. Nor were there any significant differences in survival, the 1-month, 1-year, and 5-year rates being 87.8%, 82.1%, and 68.8%, respectively, in the younger group and 85.7%, 78.6%, and 73.4%, respectively, in the older. CONCLUSIONS: Among carefully selected patients aged more than 65 years, HT can be performed without incurring greater risk of rejection, malignancy, or death than is found among recipients younger than 65 years.

[Dislocation of the knee with isolated posterior cruciate ligament rupture]. / Luxation du genou avec rupture isolée du ligament croisé postérieur.

We report a case of posterior femorotibial dislocation with an isolated lesion of the posterior cruciate ligament. Outcome was favorable after reduction and conservative treatment for six weeks and was satisfactory at six months follow-up. Acceptable functional results can be obtained after non-operative treatment of this very severe knee injury.

Differential induction profile of drug-metabolizing enzymes after treatment with hypolipidaemic agents.

Various hypolipidaemic agents differentially induced microsomal drug-metabolizing enzymes. Clofibrate, clofibric acid, fenofibric acid and dulofibrate, which are mainly hypotriglyceridaemic, increased the content in cytochromes P-450 (77-185% over control), and especially cytochrome P-452-dependent lauric acid 12-hydroxylation (5.6- to 8.4-fold increase). Bilirubin glucuronidation was 2.1- to 2.8-fold stimulated; epoxide hydrolase activity (benzo(a)pyrene-oxide) was only slightly increased by the drugs. By contrast, F1379, which lowers plasma cholesterol only, did not change cytochromes P-450 content and slightly affected the 12-hydroxylation of lauric acid. It dramatically enhanced the epoxide hydrolase activity (7.6-fold), and increased (200%) the glucuronidation of planar group I substrates (4-nitrophenol, 4-methylumbelliferone, 1-naphthol). These effects were accompanied by a highly positive staining of gamma-glutamyltransferase in the liver characterized by a great number of intensively coloured foci in the periportal and perilobular area of the tissue. Treatment of rats for three weeks with F1379 did not modify this typical profile in enzyme induction. Such continuous effect could reveal some biochemical changes of hepatocytes with important toxicological relevance. Compared to the parent compound, treatment of rats with two metabolites of F1379 led to a decrease in the induction potency on epoxide hydrolase and on the forms I of UDP-glucuronosyltransferase; by contrast, the content in cytochromes P-450 was increased.

[Value of anterior arthrodesis in the treatment of fractures of the pedicles of the axis (author's transl)]. / Intérêt de l'arthrodèse antérieure dans le traitement de la fracture des pédicules de l'axis.

Many authors consider that satisfactory consolidation of fractures of the pedicles of the axis can be regularly obtained by conservative procedures. These lesions appear to be benign as far as their neurological complications are concerned, and yet a review of the world literature shows that 30 p. cent are treated surgically. In the limited number of cases where operation is justified, anterior arthrodesis through the sternomastoid with fixation by a plate appears to be less dangerous and more reliable than applying screws to the pedicles. Excellent functional results can be expected. Posterior arthrodesis appears to be less reliable, and gives poor functional results, and should be reserved for cases in which there is a combined fracture of both the odontoid and the pedicles. Anterior arthrodesis appears to be a logical choice, requiring no special surgical skills, as confirmed by the review of 257 cases reported in the published literature.

[Non-union of fractures after osteomyelitis (author's transl)]. / Les pseudarthroses post-ostéomyélitiques. Une expérience de 50 cas.

The authors have observed 50 cases of osteomyelitis complicated by un-united fractures. The sites affected were the tibia (25 cases), femur (8 cases), humerus (7 cases), forearm (5 cases), and 5 other sites. Treatment varied depending on whether the site was in a one-bone or two-bone segment. In one-bone segments, the main problem was shortening and loss of function. Deformity needs to be corrected and the site of the lesion stabilised and grafted. In two-bone segments, the main problem is deformity due to growth of the intact bone. Forearm lesions should be operated on in children but not in adults because of the capacity of the adult for functional adaptation. In the leg, tibio-fibular synostosis and transfer of the fibula to the tibia or other types of graft can be used. Bony union was always obtained, but often with severe sequelae.

[Ball and socket ankle associated with congenital synostosis of the tarsus. Report of a case (author's transl)]. / Déformation en "cupule et dôme" de l'articulation tibio-tarsienne révélatrice d'une synostose congénitale du tarse.

The author describes a case of ball and socket ankle joint in a man aged 30 years. The deformity was associated with a congenital synostosis between the talus and calcaneus, absence of the fifth toe and 2 centimetres of shortening of the limb. The literature is reviewed.

[Parosteal chondrosarcoma. A report of two cases]. / Le chondrosarcome juxta-osseux deux observations.

Parosteal chondrosarcoma is a tumour of the soft tissues different from juxta-cortical chondrosarcoma. It is extra-periosteal, has no attachment to bone and develops primary in the soft tissues. The authors review the literature and agree that the frequency of recurrence after local excision requires treatment by amputation.