[Pleuro-pericarditis developed under a leflunomide therapy]. / Pleuro-péricardite développée au décours d'un traitement par léflunomide.

Leflunomide is an immunosuppressant drug used in rheumatoid arthritis and psoriatic arthritis. This product may cause rare but serious interstitial lung disease that appear at the beginning of treatment. This is why leflunomide should be prescribed and monitored in hospital. We present the case of a 71 years old woman who presented a pleuro-pericarditis with an increase of CA 125 during a treatment with leflunomide. This is the second case reported in the literature. The outcome was favorable after discontinuation of leflunomide.

[Cleft lip and palate treatment in the plastic surgery department in the university hospital center in Lille]. / Prise en charge des fentes labio-maxillo-palatines au sein du service de chirurgie plastique du centre hospitalier universitaire de Lille.

The aim of cleft care is to favor a normal socialization of patients with fewer therapeutic coercion. It supposes a full multidisciplinary team including psychologist, speech therapeutic, dental orthopedist, oto-rhino-laryngologist and surgeons. All of them have to be well trained which supposes a sufficient amount of cases: anglo-saxon studies have proven that a mean of at least 20 new cases per year of primary cleft were necessary. With purposes to enhance the effectiveness of treatment: prospective studies and measurements of results must be evaluated with the help of objective criteria. These are the goals of our team in lille. Our surgical principles are those of functional procedures, which privilege the muscle function's repair.

[Long-term treatment of Alzheimer's disease: followup of a cohort of 255 patients treated with lacrine for four years]. / Traitement de la maladie d'Alzheimer au long cours: à propos d'une cohorte de 255 patients traités quatre ans par tacrine.

We describe the follow-up of a cohort of 255 Alzheimer's disease (AD) patients (81 males, 174 females) treated by tacrine during 4 years. We performed the survey of hepatic, cholinergic and general tolérance. Drug efficacy was measured by MMS examination on weeks 0, 18, 30, 52, 104, 156 and 208. A total of 190 patients (74.5 percent) were dropped out of this study, 75 (29 percent) for adverse events. We found 85 hepatic (33 percent), 79 cholinergic (31 percent), 31 (12 percent) neuropsychiatric and 72 general (28 percent) side effects. In term of drug efficacy we observed a global decline of 2.5 MMS points during the first year and 2 MMS points between W52 and W156. Tacrine's symptomatic efficacy, defined as the number of patients improved or stabilized at W30, was present in 50 patients (46 percent) among the 109 patients reaching W30. The intensity of symptomatic efficacy was expressed by a 2.7 MMS points increase in 37 patients improved on W30. The long term effects of Tacrine, measured by the MMS score at one year, showed a positive impact as the MMS was 2.5 points above the expected score in non treated AD patients. This study raises the practical problem of optimal cholinesterase inhibitors use in AD and the theoretical question of long term action of cholinesterase inhibitors on cerebral lesions of AD.

Orodigitofacial syndromes type I and II: clinical and surgical studies.

Eleven patients were followed at the multidisciplinary facial cleft department from 1963 to 1993. Nine had orodigitofacial (ODF) I syndrome (Papillon-Leage, 1954) and two had ODF II syndrome (Mohr, 1941). The authors observed seven median clefts of the upper lip, eight atypical cleft palates, nine lingual tumors, ten polylobed tongues, four ankyloglossia. All vestibular frenula were hypertrophied. Facial analysis showed five facial hypertelorisms, eight epicanthal folds, ten anomalies of the forehead. Nasal anomalies were constant with ten alar hypoplasia and four nasal curves. Syndactyly was the most frequent anomaly of the hand. Seven patients were mentally retarded. Transmission of ODF I is by X-linked dominant variable expression; ODF II is autosomal recessive. The difference in transmission means a precise diagnosis is necessary. Bilateral duplication of the great toe is characteristic of type II, but not pathognomonic. Hair and cutaneous anomalies suggest type I. The authors proposed a surgical treatment involving three operating steps.

[Bone age and maxillo-mandibular dysharmony in children with cleft lip and palate]. / Age osseux et dysharmonies maxillo-mandibulaires chez les enfants porteurs de fentes labio-palatines.

The clinical examination, the bone age and the palatine surgical trauma served to evaluate the factors producing maxillo-mandibular dysharmonies in cleft lip/palate patients. 55 patients with total unilateral cleft lip and palate aged from 10 months to 13 years were used for this study. By clinical examination the patients were divided in: group A--37 cases without dysharmonies and B--18 cases with dysharmonies. By the bone age examination: group N--39 cases with normal variations (+/- 1.99 SDS) or acceleration (+2.00 SDS) and group R--16 cases with retardation (-2.00 SDS). By the surgical trauma: group M--11 cases with multiples operations and K--44 cases as "control" group. The correlations between the three factors showed that for the prognosis of maxillo-mandibular dysharmonies are significant: 1. The surgical trauma--73% of the patients with multiples operations (group M) are also part of the group B (with dysharmonies), versus 23% for the "control" group K (p < 0.001). 2. The retardation of the bone age--50% of the patients of the B group have retarded bone age, versus 24% of the patients of the group A (p < 0.05). 56% of the patients of the group R (with retardation) are part of the group B, versus 23% of the group N (p < 0.02). The retardation of the bone age is a factor of risk for maxillo-mandibular dysharmonies in cleft lip/palate children, which means that in these cases, the treatment and the control should be more attentive, beginning as soon as possible.

[Rotation flap from the anterior tonsillar pillar for the reconstruction of the intermaxillary commissure and posterior portion of the cheek]. / Lambeau de rotation du pilier antérieur de l'amygdale pour reconstruire la commissure intermaxillaire et la partie postérieure de la joue.

A modified technique is presented, which is based on Kazanjian and Hynes' methods using a lateral pharyngeal flap, and which provides a simple means of repair of loss of mucosal substance from the intermaxillary area or the posterior two-thirds of the cheek.