[Pharmacological Thromboprophylaxis in Acutely Ill Hospitalized Medical Patients]. / Thromboprophylaxie pharmacologique chez les patients hospitalisés pour une affection médicale aiguë.

Venous thromboembolic events (VTE) occur in approximately 50% of cases during or following hospitalization; VTE are a major cause of morbidity and mortality. Thromboprophylaxis for 6 to 14 days with heparins or fondaparinux has been demonstrated to be effective in VTE prevention in patients hospitalized for acute medical illnesses and reduced mobility. Nevertheless, the level of recommendation has been gradually downgraded as the benefit has been mainly demonstrated on the basis of systematic imaging diagnosed events. Direct oral anticoagulants have been assessed only as an extended prophylaxis, and are currently not recommended in medical thromboprophylaxis. Assessing the risk of VTE and bleeding in medical patients is complex. VTE and bleeding risk assessment scores were constructed but have not been validated. In order to improve the adequacy of prescriptions for thromboprophylaxis, the impact of different interventions has been the subject of several studies but these yielded varying results. The aim of this review is to analyze the indications for thromboprophylaxis in a medical setting with the latest available data.

Social cognition in autism is associated with the neurodevelopment of the posterior superior temporal sulcus.

OBJECTIVE: The posterior superior temporal sulcus (pSTS) plays a critical role in the 'social brain'. Its neurodevelopment and relationship with the social impairment in autism spectrum disorders (ASD) are not well understood. We explored the relationship between social cognition and the neurodevelopment of the pSTS in ASD. METHOD: We included 44 adults with high-functioning ASD and 36 controls. We assessed their performances on the 'Reading the mind in the eyes' test (for 34 of 44 subjects with ASD and 30 of 36 controls), their fixation time on the eyes with eye tracking (for 35 of 44 subjects with ASD and 30 of 36 controls) and the morphology of the caudal branches of the pSTS (length and depth), markers of the neurodevelopment, with structural MRI. RESULTS: The right anterior caudal ramus of the pSTS was significantly longer in patients with ASD compared with controls (52.6 mm vs. 38.3 mm; P = 1.4 × 10-3 ; Cohen's d = 0.76). Its length negatively correlated with fixation time on the eyes (P = 0.03) in the ASD group and with the 'Reading the mind in the eyes' test scores in both groups (P = 0.03). CONCLUSION: Our findings suggest that the neurodevelopment of the pSTS is related to the ASD social impairments.

[Giant recurrent trochanteric pressure sore: A complex medico-surgical care]. / Escarre trochantérienne géante récidivante : une prise en charge médico-chirurgicale complexe.

BACKGROUND: Pressure sores are a frequent complication in spinal injured people. Their treatment is often long and complex. OBSERVATION: We report the case of a 60-year-old man affected with complete paraplegia who developed a right trochanteric pressure ulcer complicated with osteoarthritis of the coxofemoral joint. The treatment was done in three steps. First, a large excision of necrotic tissues and a femoral head-neck resection is performed. Then, the defect is partly covered with a Gluteus Maximus and a Biceps Femoris myocutaneous flaps. Finally, the residual defect is covered with a cutaneous pedicled groin flap called McGregor's flap. Later, the patient showed a right para-scrotal pressure sore on a heterotopic ossification of the ischial tuberosity. DISCUSSION: McGregor's flap is rarely employed for treating trochanteric pressure sores. It was here the only pedicled flap available. It was necessary to autonomize it in order to get enough length and to place a hip external fixation. The para-scrotal pressure sore illustrates the fact that bone resection surgery lifts the weight-bearing zones and can lead to pressure sores in unusual locations. CONCLUSION: The surgical treatment of these "giant" pressure sores requires a perfect collaboration between teams of rehabilitation and several surgical areas. Without a good adherence of the patient, the treatment is doomed to fail.

Refractory pyoderma gangrenosum treated with infliximab in an infant.

We report the case of an 11-month-old boy with severe recalcitrant pyoderma gangrenosum refractory to prednisone, dapsone and ciclosporin. Treatment with infliximab was well tolerated, and resulted in an excellent clinical response that has been sustained for 15 months. The characteristics of this condition in children and the use of infliximab in infants are both reviewed.

[Surgical repair of the axillary nerve. Results of a five-year follow-up]. / Réparations chirurgicales du nerf axillaire. Résultats à cinq ans de recul.

INTRODUCTION: We report a series of 19 cases of axillary nerve lesions, which were operated between 1981 and 1995. MATERIAL AND METHODS: There were 14 isolated lesions of the axillary nerve and in 5 patients the lesion to the axillary nerve was associated either with a lesion of the radial nerve or with a lesion of the suprascapular nerve. Fourteen patients sustained shoulder stretch injury, three had fractures of the scapular girdle and two anterior shoulder dislocation. Patients were operated on 9 months after trauma through a combined anterior and posterior approach. The lesion was located in the quadrilateral space. In 17 cases the neuroma was excised and the nerve was reconstituted, using sural nerve grafts. In two cases the nerve was only freed from the surrounding scar tissue. RESULTS: Results were considered as satisfactory in 10 out of 14 isolated axillary nerve lesions. According the Constant score there were 2 very good, 8 good and 2 fair results. In this study, neurolysis and axillary nerve associated with suprascapular nerve lesions gave poor results. DISCUSSION: The successfully reinnervated deltoid muscle adds strength and endurance to the affected shoulder. Electromyographic study remains important in detecting spontaneous return of muscle function and determining the most favorable operative period before severe amyotrophy appears.

[Use of "foot-bank" tissue to cover amputation stumps. Apropos of 4 cases]. / Utilisation du "pied-banque" pour la couverture des moignons d'amputation. A propos de 4 cas.

PURPOSE OF THE STUDY: The authors report 4 cases of plantar skin free transfer to cover an amputation stump. MATERIAL AND METHODS: In two cases, operated as emergencies, a flap based on the posterior tibial pedicle was harvested from a non-reimplantable extremity. In one case the calcaneum was included in the flap to provide a stump wide enough to hold a prosthesis. The two others cases concerned planned amputation of non-functional extremities, with free transfer of the available plantar skin areas. RESULTS: All 4 patients healed well and the skin coverage provided a good quality stump which was rapidly equipped with prostheses. DISCUSSION: Covering amputation stumps with a free flap from the foot bank has proven to be a reliable procedure, economic for the patient, affording a good physiologic bearing surface. CONCLUSION: This method should proposed in emergency amputations according to local conditions, and may also be advantageous in some cases of secondary surgery.

[The externe fixations]. / Les fixateurs externes.

The authors will highlight the advantages of external fixation in the treatment of open fractures of the leg.The first is stabilisation of the fracture site. It is obtained by using transfixion pins in multiple planes (the ideal being 2 planes between 60 and 90°). With flexible pins, stability is obtained by using multiple pins and fixing them to rings under tension.The second advantage is to allow secondary reduction and encourage consolidation by compression, distraction or dynamisation (according to Ilizarov).The third advantage is to leave the adjacent joint free which is sometimes difficult with epiphyseal and metaphyseal fractures even with the newer fixators. Preserving muscle function is sometimes difficult and depends on pin position.The fourth advantage is to be able to obtain skin cover although the use of flaps may be compromised by the pin tracks.The ideal therefore in open fractures of the leg is to fix the fracture site by pins at a distance from the fracture, to obtain skin cover after the fracture has been stabilised and then complete the assembly of the fixator.

[Open tibial fractures - The series of clermont-ferrand]. / Les fractures ouvertes de jambe - La série de Clermont-Ferrand.

The authors report a series of 9 cases over the period 1981-1992.Debridement was achieved in a single procedure in 44.5% of the cases, in 2 procedures in 33.3%, in more than 2 procedures in 22.2%. The closure of the wound was achieved by secondary sature in 77.8% of the cases and by a muscule flap in 22.2%. The fixation of the fracture was performed by an external fixator in all cases.Primary consolidation was obtained in 44.4% of the cases. A tibiofibular graft was needed in 4 cases.The mean time to consolidation was 23 months.

[Stewart-Treves syndrome. Immunohistochemical study apropos of 2 cases]. / Syndrome de Stewart-Treves. Etude immunohistochimique de 2 cas.

Two women (63 and 68 years) presented with primary angiosarcomas of the skin which had developed on an area of chronic lymphoedema after radiosurgical treatment for breast cancer 4 and 13 years earlier. Immunohistochemistry tests formally eliminated epithelial metastasis and produced evidence in favour of lymphatic or capillary vascular proliferation. Endothelial affinity for anti-factor VIII and positive tests for certain markers of intermediary filaments (actin, vimentin) confirmed the vascular and conjunctive tissue origin of the tumours.

No inhibition of corticotrophin (ACTH)-hypersecretion in adrenal insufficiency by somatostatin.

Somatostatin (250 micrograms as a bolus iv and 250 micrograms as a 1 h infusion) was administered to 6 patients with primary adrenal insufficiency (Addison's disease). The fall in plasma ACTH during the infusion period ranged between 0-30% with a mean reduction of 11.2 +/- 11.6%. These findings suggest that with the method employed, somatostatin is not an inhibitor of ACTH secretion in a condition in which glucocorticoids are lacking.