Second phalanx shortening osteotomy. An innovative technique for long second toe syndrome

Long second-toe syndrome, although frequent and disabling, has been little described. Current surgical techniques often lead to loss of function. Based on anatomical and biomechanical observations, the present study reports a second phalanx shortening osteotomy technique. The procedure is relatively non-invasive, involving self-stabilizing segment resection osteotomy of the second phalanx. Results for the first 23 feet undergoing the procedure were analyzed retrospectively. Assessment comprised clinical examination, radiography and AOFAS and FAAM scores. Mean follow-up was 19±9.9 months. Second phalanx shortening osteotomy proved reliable, respecting the biomechanics of the toe.

Épidémiologie et résistance aux antibiotiques de Streptococcus pneumoniae en Île de France en 2001

OBJECTIVE

The authors wanted to assess the level of Streptococcus pneumoniae antibiotic resistance in Ile de France.

METHOD

In 2001, 637 clinical strains of S. pneumoniae were prospectively collected from 32 microbiology laboratories.

RESULTS

Fifty one percent of strains were isolated from children under 15 years of age and 49% from adults. In children, 76% of strains came from otitis media, 20% from blood culture, in adults most strains (92%) came from blood culture. The overall prevalence of non-susceptible penicillin pneumococci was 61% higher in children (73%) than in adults (50%). Among the non-susceptible penicillin pneumococci 21.8% were resistant (CMI > 1 mg/l). Strains with decreased susceptibility to amoxicillin and cefotaxime were 38% and 17% respectively. Resistant strains to these two drugs (CMI > 2 mg/l) were rare 2.6% and 0.4% respectively. Among other antimicrobial agents, rate of resistance was 63% to erythromycin, 47% to cotrimoxazole, 40% to tetracycline, and 23% to chloramphenicol. The most frequent serogroups were serogroups 19 and 14, respectively 23% and 18%. Serotypes included in heptavalent vaccine covered 90% of children strains under 2 years of age.

CONCLUSIONS

The prevalence of resistance to penicillin was high in children particularly in otitis media pus (76%).

[Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases]

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.

[Piperacillin in in vitro-in vivo combination]

Launched two years ago, piperacillin is administered either alone or combined with other antibiotics. Broadening the antibacterial spectrum, looking for synergism and preventing the emergence of resistant mutants constitute a major preoccupation, especially in immunodepressed patients, and an indication for combined antibiotic therapy. The most effective combination, justified by in vitro tests, consists of a beta-lactam antibiotic and an aminoglycoside. In vitro studies have demonstrated an antagonistic effect between two beta-lactam antibiotics, and mutants have been isolated in vivo. The results obtained with the piperacillin-vancomycin combination are not as good as those obtained with previous combinations. The advent of new compounds, such as aztreonam, fluorinated quinolones and beta-lactamase inhibitors offers hopes of excellent results.

Therapeutic considerations in congenital absence of the right pulmonary artery. Use of internal mammary artery as a preparatory shunt

Congenital unilateral absence of a pulmonary artery is rare. When present, it is usually associated with other cardiac malformations. In this communication an infant with coarctation of the aorta, ventricular septal defect and absent right pulmonary artery is reported. After correction of the first two defects, due to persistent respiratory difficulty, the infant had exploration of the right pulmonary hilum in hopes of finding a pulmonary artery remnant and re-establishing blood flow to that lung. A small hilar vessel supplying all three lobes of the right lung was found and as a first stage, to enhance pulmonary arterial growth, a palliative systemic to pulmonary artery shunt was performed utilizing a large internal mammary artery. This is the first report of a case in which the internal mammary artery is used in an infant to establish systemic to pulmonary arterial flow in congenital unilateral absence of a pulmonary artery.