[Maternal anxiety related to how the pediatrician provided prenatal information about preterm birth]

INTRODUCTION

Women hospitalized for preterm labor require clear information about prematurity. This study assessed whether or not specific written information about prematurity delivered at admission to the unit combined with an oral explanation from a pediatrician would decrease women's anxiety compared to an oral explanation alone.

MATERIAL AND METHODS

This was a prospective, single-center observational study. Women were included in the high-risk pregnancies department and distributed into two groups: receiving "only oral" information for a prenatal clinical consultation with a senior pediatrician or receiving "combined" oral information+a booklet about prematurity given to the women at admission. The primary endpoint was the change in anxiety-state (before and after the information procedure) evaluated by the State Trait Anxiety Inventory-Y (STAI-Y).

RESULTS

The anxiety score before receiving information did not differ between the two groups (STAI-Y-A "combined" group: 46.7±3.0 vs. "only oral" group: 42.7±2.74; P=0.55). After consultation with a pediatrician, the acute anxiety-state score STAI-Y-A decreased significantly in the "combined" group (-6.7±1.9) compared to the "only oral" group (-2.5±4.6; P<0.05).

DISCUSSION

A booklet about prematurity combined with oral information from a pediatrician reduced patients' anxiety more than oral information alone. Given that the psychology of the mother interacts with the pregnancy, it is necessary to provide clear and adapted information. Giving a booklet appears to be one of the modalities to improve information. Other modalities such as video documents have to be studied.

Safety and tolerability of subcutaneous treprostinil in newborns with congenital diaphragmatic hernia and life-threatening pulmonary hypertension

BACKGROUND

Prolonged pulmonary hypertension (PH) is highly predictive for pulmonary morbidity and death in infants with congenital diaphragmatic hernia (CDH).

OBJECTIVES

To report the effects and tolerability of subcutaneous treprostinil in newborns with severe CDH and late life-threatening PH.

METHODS

We recorded clinical and echocardiography data before and after starting subcutaneous treprostinil, on patients with severe CDH and late PH, refractory to inhaled nitric oxide and oral sildenafil.

RESULTS

14 patients were treated with treprostinil (gestational age: 39.1±2.0weeks; birth weight: 3200±600g). Prior to treatment, the pre- and post-ductal SpO2 difference (Δ SpO2) was 14±10%. Treprostinil was initiated at a median age of 12days [5-157]. After starting treprostinil, ΔSpO2 decreased to 3% at day 7 (p<0.05), and the mean blood flow velocities in the right pulmonary arteries increased by 110% (p<0.05). 2 of the 14 patients died. At the age of follow up (12months to 3years), the 12 surviving infants were all weaned from respiratory support and discharged home.

CONCLUSION

The subcutaneous treprostinil improves pulmonary hemodynamics and outcomes in infants with CDH and life-threatening PH. We suggest that the treatment should be considered in infants with severe CDH and late PH.

TYPE OF STUDY

Case series with no comparison group.

LEVEL OF EVIDENCE

Level IV.

Characteristics of endobronchial primitive tumors in children

Primary endobronchial tumors are rare in children and they include a broad spectrum of lesions. The aim of this study was to determine the characteristic features, treatments and outcomes of these tumors. We report a retrospective analysis of all patients treated for endobronchial tumor in nine French hospitals between 1990 and 2010 and a comparison of the results with those reported in the medical literature. Twelve tumors were reported: five low grade muco epidermoid carcinomas, two inflammatory myofibroblastic tumors, two hemangiomas, one anaplastic large cell lymphoma, one carcinoid tumor, and one juvenile xanthogranuloma. The mean age of the patients was 7.5 ± 3.5 years. The most common sign revealing the disease was persistent atelectasis or recurrent pneumonia (eight cases). The other revealing signs were a persistent bronchospasm (three cases) and hemoptysis (one case). The clinical presentation, biology, serum tumor markers, and chest X-ray abnormalities were not specific to a particular histological diagnosis. Chest CT scan revealed the presence of an endobronchial tumor in 11 cases. Nine tumors could be diagnosed from a biopsy obtained by video endoscopy. Complete surgical resection was performed in seven patients. Bronchoscopic removal was performed in five cases and was successful in three. There were no deaths. Endobronchial tumors are rare in childhood and their histology is diverse. Chest CT scan and per-endoscopic endobronchial biopsies are required for diagnosis, when possible. Surgical or endoscopic treatment should be discussed by a multidisciplinary team. Despite the multiple etiologies, the prognosis of these tumors is good if diagnosis is early and if resection is complete. Long-term recurrences have been described, so long-term follow-up of these children is recommended.

A simple surgical treatment for acute traumatic sternoclavicular dislocation

Sternoclavicular lesions may sometimes require surgery. Many techniques have been described and they appear to be very demanding. We describe a simple technique using two screws and a strong suture (Arthrex Inc. Naples. FL 34108 USA). Level of evidence; Level IV, Case Series, Treatment Study.

Wormian bones in a general paediatric population

Wormian bones are small bones that are often found within the sutures and fontanelles of the skull. When a child presents an unexplained fracture or fracture(s), osteogenesis imperfecta is usually suggested when an "abnormally high number" of fractures are seen.

PURPOSE

To assess the frequency, number, and topography of wormian bones in a "normal" paediatric population.

MATERIALS AND METHODS

In a population aged from 0 to 3 years, we retrospectively analysed 605 CT brain scans carried out for a range of indications, excluding cases in which there was a suspicion of constitutional bone disease.

RESULTS

In our population, wormian bones were found in 53% of children (n=320): 43% of the children had between one and three (n=260), 10% had four or more (n=60), and 6% had five or more (n=40). There was no significant relationship between the number of wormian bones and the various indications that had led to the CT scan being carried out. Wormian bones in the lambdoid suture were found in by far the greatest numbers.

CONCLUSION

Wormian bones are common and can sometimes be numerous without necessarily pointing to osteogenesis imperfecta, since 10% of the children in our study had at least four.

The concordance of MRI and arthroscopy in traumatic meniscal lesions in children

INTRODUCTION

Traumatic meniscal lesions in children must be diagnosed quickly and efficiently as a priority in order to conserve the meniscus and safeguard the future of the knee. They are often isolated and difficult to identify clinically. In the diagnostic work up stage, an excessive resort to diagnostic arthroscopy has given way to increasing use of MRI by radiologists without pediatric specialization. The present study examined the agreement between MRI aspect and arthroscopic exploration in traumatic meniscal lesions in children.

PATIENTS AND METHODS

Sixty-nine knees in children aged 9 to 16 years having undergone MRI followed by arthroscopy for knee trauma between 1995 and 2008 were included in a retrospective design. Discoid meniscus was excluded. Files were reviewed by a single clinician and MRI scans by a radiologist specialized in pediatric pathology. Cases of epiphyseal fusion were excluded. All files were analyzable. Agreement with arthroscopic findings as reference was assessed for presence, location and type of meniscal lesion.

RESULTS

Overall agreement with arthroscopy was respectively 78% and 82% on first and second MRI readings: 77% and 80% for the medial, and 78% and 84% for the lateral meniscus. On the first reading, there were 13 false positives for the medial and 5 for the lateral meniscus, versus 9 and 0 respectively on second reading. Overall sensitivity was 70% on first reading and 64% on second, and overall specificity 81% and 90%, respectively.

DISCUSSION

The present results, in line with the literature, may appear encouraging, but hide considerable disparity between analysis of the medial and of the lateral meniscus: MRI overestimated medial and underestimated lateral meniscus lesions.

CONCLUSION

MRI serves only as a support and does not provide sure diagnosis of meniscus lesion. Interpretation should take account of the clinical examination and the pediatric orthopedic specialist's experience.

Ostéosynthèse antérieure par plaque à tête de vis verrouillée DRP 2.4™ dans les fractures à déplacement postérieur de l'extrémité distale du radius. À propos de 22 cas

OBJECTIVE

Our first experience of palmar plating for dorsally displaced distal radius fracture with locking compression plate showed good results. But ancillary tools was ineffective, so we report our early experience with the DRP 2,4 device.

METHODS

Between January and October 2004, 22 patients (16 women, 6 men), mean age 56,8 years (age range: 24-77 years), underwent internal reduction and fixation using DRP 2.4 by Henry's approach. By AO classification there was 10 A3 and 12 C1 or C2 fracture. On pre operative X Ray, radial inclination was 13.9 degrees , and dorsal tilt was 27 degrees .

RESULTS

Seventeen patients were reviewed with mean follow-up of 11 months (5 to 17). On postoperative X Ray, radial inclination was 22,7 degrees and palmar tilt was 2,1 degrees. At 6 month radiological findings found no loss of postoperative reduction. According to SOFCOT's criteria's, we noticed 9 anatomical results and 8 moderate malunion. Clinical results (Green and O'Brien) showed 6 excellent, 7 good, 4 fair and no poor results. Mean DASH score was 13.5. Strength recovery was 82% of opposite side. Complications concerning 6 patients with, 4 reflex sympathetic dystrophy, and 2 screwdriver breakage during insertion.

DISCUSSION

Volar plating with DRP 2.4 is an effective technique, but obtain anatomical reduction remind challenging for the surgeon.

CONCLUSION

DRP 2.4 volar plating is an effective treatment for dorsally displaced fracture. Controlled study with orthopaedic reduction and K Wire fixation are need for determining the place of each treatment.

[Can US-guided vacuum-assisted biopsies be an alternative to diagnostic surgery in cases of non-diagnostic core needle biopsy?]

PURPOSE

To assess US-guided vacuum-assisted biopsies in the diagnosis of suspicious sonographic breast lesions after non-diagnostic core needle biopsies (CNB).

PATIENTS AND METHODS

Retrospective study of 42 females with suspicious breast lesions at US. CNB previously performed were non-diagnostic. Because of the larger sample size, vacuum-assisted biopsies were performed, instead of surgical biopsy.

RESULTS

Vacuum-assisted biopsies showed 32 benign lesions. Histologic examination of the CNB showed non-specific fibrous tissue in 43% of cases as opposed to 7.1% for vacuum-assisted biopsies. The latter provided a more specific diagnosis (mainly fibrocystic breast disease). From a total of 4 lesions that were suspicious at CNB, 3 were diagnosed as malignancies after vacuum-assisted biopsy and one case was a "borderline" lesion. Three additional malignant and three additional borderline lesions were diagnosed on vacuum-assisted biopsies. In 11 cases, surgical excision was performed, and all diagnoses from vacuum-assisted biopsies were confirmed at microscopy, except in one case where it was underestimated (ADH versus DCIS).

CONCLUSION

US-guided vacuum-assisted biopsy is a reliable technique. Because it provides more tissue than CNB, it can be an alternative to diagnostic surgery after non-diagnostic CNB. Indeed, it allows confirmation of the diagnosis and provides a more specific diagnosis of benign lesions. With regards to malignant and borderline lesions, it avoids the risk of false-negative CNB and overlooking carcinomas.

Transient gene expression in HEK293 cells: Peptone addition posttransfection improves recombinant protein synthesis

Gene expression by large-scale transfection of mammalian cells is becoming an established technology for the fast production of milligram and even gram amounts of recombinant proteins (r-proteins). However, efforts are still needed to optimize production parameters in order to maximize volumetric productivities while maintaining product quality. In this study, transfection efficiency and volumetric productivity following transient gene expression in HEK293 cells were evaluated using green fluorescent protein (GFP) and human placental secreted alkaline phosphatase (SEAP) as reporter genes. We show that a single pulse of peptones (protein hydrolysates) to the cultures performed in a low serum (1%, v/v) and in serum-free medium results in a significant increase in volumetric protein productivity. Sixteen peptones from different sources were tested and almost all of them showed a positive effect on r-protein production. This effect, however, is time- and concentration-dependent. By using Tryptone N1 (a casein peptone, TN1) to feed the cultures at 24 h posttransfection (hpt), a 2-fold increase in volumetric SEAP productivity was obtained 5 days posttransfection. This effect was shown to be equal to that obtained when the culture was fed with a supplementary 4% (v/v) of serum. The positive effect of TN1 on protein production was also demonstrated with Tie2 protein ectodomain produced in serum-free medium. HPLC analysis of amino acids consumption/production during control batch and TN1 pulse culture showed some major differences in amino acid metabolism when using TN1 pulse. Asparagine, glycine, histidine, threonine, leucine, and valine show accumulation in the medium over the cultivation period instead of being consumed as observed in unfed sample (except for asparagine, which remained unchanged). Isoleucine, tyrosine, methionine, and phenylalanine all remained unchanged or slightly fluctuated in TN1-fed culture after the feeding pulse, while they were all steadily consumed in the control run. The relative abundance of SEAP's mRNA suggests that the improvement in protein yield results both from an increase of the translational activity and transcription efficiency. Further understanding of mechanisms by which amino acids/peptides regulate transcriptional and translational machinery in mammalian cells should facilitate the design of new strategies for the improvement of r-protein production by large-scale transfection.

Increased production of active human beta(2)-adrenergic/G(alphas) fusion receptor in Sf-9 cells using nutrient limiting conditions

Using the baculovirus/insect-cell expression vector system, we succeeded in obtaining a high yield of active human beta(2)-adrenergic receptor/G(alphas) fusion protein. This was achieved following high cell density production under nutrient-limiting conditions using a very low multiplicity of infection (MOI). This approach was found to significantly reduce inactive protein accumulation that occurred when production was done using conventional high MOI procedures. The maximum specific and volumetric yields of active receptor using this strategy increased by factors of two- and sixfold, respectively. Our results suggest that the increase in the ratio of active/total protein produced results from production under nutrient limitation. Since low multiplicity of infection offers many advantages for large-scale applications, we suggest that this simple production method should be considered when optimizing expression of G-protein-coupled receptors and other complex proteins.

Regulation of a wheat actin-depolymerizing factor during cold acclimation

We have previously shown that the wheat (Triticum aestivum) TaADF gene expression level is correlated with the plants capacity to tolerate freezing. Sequence analysis revealed that this gene encodes a protein homologous to members of the actin-depolymerizing factor (ADF)/cofilin family. We report here on the characterization of the recombinant TaADF protein. Assays for ADF activity showed that TaADF is capable of sequestering actin, preventing nucleotide exchange, and inducing actin depolymerization. In vitro phosphorylation studies showed that TaADF is a substrate for a wheat 52-kD kinase. The activity of this kinase is modulated by low temperature during the acclimation period. Western-blot analyses revealed that TaADF is expressed only in cold-acclimated Gramineae species and that the accumulation level is much higher in the freezing-tolerant wheat cultivars compared with the less tolerant ones. This accumulation was found to be regulated by a factor(s) encoded by a gene(s) located on chromosome 5A, the chromosome most often found to be associated with cold hardiness. The induction of an active ADF during cold acclimation and the correlation with an increased freezing tolerance suggest that the protein may be required for the cytoskeletal rearrangements that may occur upon low temperature exposure. These remodelings might be important for the enhancement of freezing tolerance.

A blind study of the polymerase chain reaction for the detection of Mycobacterium tuberculosis DNA. Azay Mycobacteria Study Group

SETTING

Nine French laboratories routinely involved in mycobacterial work.

OBJECTIVE

To assess the detection of Mycobacterium tuberculosis in experimental samples by polymerase chain reaction (PCR) using the insertion sequence IS6110 as a target for deoxyribonucleic acid (DNA) amplification.

DESIGN

Nine laboratories participated in a blind study of the detection of M. tuberculosis by PCR in 20 coded samples containing either a definite number of M. tuberculosis complex (positive samples) or environmental mycobacteria (four samples) or no mycobacteria (five samples).

RESULTS

Five laboratories reported false-positive PCR results, with an average rate of 7%. All laboratories except one reported positive PCR results for samples containing 10(5) cfu/ml or more. M. tuberculosis DNA was detected in two thirds of samples containing 10(4) and 10(3) cfu/ml, and in one third of the samples containing 10(2) cfu/ml.

CONCLUSION

The results of the study suggest that PCR using IS6110 as a target for DNA amplication is neither very sensitive nor really specific for the detection of M. tuberculosis.

Identification and characterization of a low temperature regulated gene encoding an actin-binding protein from wheat

A cDNA corresponding to a putative actin-binding protein was cloned from a cold-acclimated wheat cDNA library. The cDNA, designated Wcor719, encodes a polypeptide of 142 amino acids with a calculated molecular mass of 15.8 kDa and a pI of 4.27. The protein has the two conserved domains identified as actin and phosphatidylinositol 4,5-biphosphate (PIP2) binding sites found in members of the cofilin family. Northern analyses revealed that Wcor719 transcript accumulation is rapid and strongly up-regulated by low temperature. This accumulation was greater in the tolerant winter wheat and rye species compared to the less tolerant ones. The rapidity of transcript induction and the significant homology with actin-binding proteins (ABP) from different organisms suggest that the product of this gene might be involved in the dynamic reorganization of the cytoskeleton during low temperature acclimation. It may also serve as a key factor in the signal transduction pathway during cold acclimation.

Diagnosis of tuberculosis by Amplicor Mycobacterium tuberculosis test: a multicenter study

The Amplicor Mycobacterium tuberculosis test is a new PCR assay for the direct detection of Mycobacterium tuberculosis from clinical samples. A multicenter study that included six laboratories was done to evaluate the Amplicor test in comparison with direct microscopy and culture (solid or radiometric media), and the culture method was used as the "gold standard." A total of 2,073 specimens, i.e., 1,749 respiratory specimens and 324 other specimens, were tested. A total of 184 cultures yielded M. tuberculosis. Of these 184 cultures, 77 (42%) were smear negative and 23 (12.5%) concerned extrapulmonary specimens. The sensitivity of the Amplicor test for all of the specimens and for extrapulmonary, smear-positive, and smear-negative specimens was 86, 83, 94.5, and 74%, respectively. The sensitivity of direct microscopy in comparison with that of culture was 58%. A total of 95% of patients with culture-proven tuberculosis were diagnosed by the Amplicor test, whereas direct microscopy detected mycobacteria in only 72% of these patients. The Amplicor test exhibited a high degree of specificity (98%). The assay was very rapid and easy to perform.

[Bacteriological diagnosis of tuberculosis: current hieratic classification of methods]

To assure the diagnosis of tuberculosis, one needs the observation, the isolation and the identification of the causative agent Mycobacterium tuberculosis. In this approach, the microscopic exam occurs as a fast but neither sensitive or specific test. The isolation on solid media is slow and needs more than three weeks before becoming positive. Nevertheless, it is a sensitive and specific one. The identification of the isolated strain and the study of sensitivity to antibiotic agents require an equal delay. Then, 2 months are necessary to achieve the analysis. The AIDS epidemic with the increase of opportunistic mycobacterial diseases, and the unexpected arrival of resistant Mycobacteria is creating as a difficult therapeutic problem. The cultivation in liquid media with the radiometric method (Bactec) shortens the time of culture by half. The genomic amplification assay has been hopeful because it allowed results in 2 days. However, some technical difficulties happen when the test is conducted and it is less sensitive than the isolation process. The hierarchical classification of the laboratory useful process to establish the diagnosis of tuberculosis disease remains the microscopic observation of the bacilli and their isolation. Today, the use of PCR alone does not assure the diagnosis of tuberculosis, however it may be used as a additional diagnostic test.

[Use of the Bactec TB 460 method for the bacteriological diagnosis of tuberculosis. Results of a multicenter study]

Isolation of Mycobacteria on Loewenstein-Jensen medium lasts many weeks. The use of Radiometric method (Bactec TB 460) reduces the delays. Results of 79,064 cultures are reported from a multicentric study associating 16 laboratories. The average was 4.8% of positivity and 2.51% of contamination. The comparison of the results with conventional method previously obtained shows that radiometric method is more sensitive and contaminations are less numerous. Concerning hemocultures the Bactec method is very usefull. Among 11,277 tests performed 907 were positive (8.04%). Mycobacterium avium was identified in 89% of the cases. Identification test utilizes Biochemical and NAP tests, but also more and more Nucleic probes. The antibiotic sensitivity is performed in five days. The mean delay of analysis is about 25 days, lessening by half the conventional method delays. Nevertheless, Bactec method has the following inconveniences: syringe inoculation, use of radiolabelled products, expensive cost.

Scaphoid nonunion: treatment by open reduction, bone graft, and staple fixation

Thirty-eight scaphoid nonunions were treated by iliac crest bone grafting and staple fixation. A distractor was inserted through an anterior incision and the scaphoid was distracted to restore its original length. The nonunion was then grafted and held with a staple. Consolidation was achieved in 36 cases despite 6 cases of partial avascular necrosis. Pain at the graft site, which was usually transient, was the only complication. Wrist extension was significantly improved. The main indication for this procedure is pseudarthrosis of the middle third of the scaphoid.

Comparison of phenotypic methods and DNA hybridization for detection of methicillin-resistant Staphylococcus aureus

One hundred thirty-eight Staphylococcus aureus isolates from patients with severe staphylococcal infections were collected in 15 French hospitals. Detection of the mec gene was performed by dot blot hybridization with a specific DNA probe. Dot blot results were used to characterize the isolates as methicillin susceptible (77 isolates) or resistant (61 isolates). The isolates were screened for methicillin resistance by an agar spread method on Mueller-Hinton plates containing oxacillin (2 and 10 micrograms/ml) and were incubated at 37 degrees C, with 10(8) CFU as the inoculum. MICs of oxacillin and methicillin were determined by the agar dilution method on Mueller-Hinton plates without NaCl, by using 10(5) CFU per spot, after 24 and 48h of incubation at 30 or 37 degrees C. Moderately elevated MICs were found for 20 isolates (14.5%). The mec gene was detected in six (30%) of the isolates expressing a low level of resistance to methicillin and/or oxacillin. As determined by comparison with probe hybridization results, the spread plate method with oxacillin at 2 micrograms/ml was more sensitive (sensitivity, 100%) and specific (specificity, 100%) than agar dilution with either methicillin or oxacillin in identifying methicillin resistance or susceptibility. Determinations of methicillin and oxacillin MICs by the agar dilution method had a specificity of 99 to 100% depending on the conditions of incubation, but the sensitivity was below 85% whatever the duration or temperature of incubation.

[Mechanisms of adhesion of Staphylococci to biomaterials: effect of fusidic acid]

The production of slime, adherence to plastics and hydrophobicity are factors which regulate the colonisation of biomaterials by Staphylococci. The influence of fusidic acid on these 3 factors was studied by using 3 pairs of pathogenic strains of S. aureus and S. epidermidis. Each pair presented differences in the expression of one or several of these factors. The influence of fusidic acid was initially studied by determining the expression of these factors by these strains cultured in the presence of 0.03 mg/l and 0.5 mg/l of antibiotic. Hydrophobicity was measured by the Bath-test method, slime was detected by Trypan blue staining after fixation with Carnoy's fixative and adherence was determined on polystyrene. The variations observed were generally minor, except for S. epidermidis, high slime produces, which showed a reduced production. Using this collection of strains, we then selected mutants resistant to 2 micrograms/ml of fusidic acid. This resistance induced a reduction in the 3 colonisation factors and it can be proposed that strains resistant to fusidic acid have a lesser capacity to colonise than sensitive strains. The bacteria adhere to and colonise the majority of surfaces proposed to them [3, 7, 10]. This was the case for biomaterials used in medicine, whose number and diversity (catheters, prostheses) are continually increasing. Apart from thrombosis, the major complication is the development of infection. Coagulase positive or negative Staphylococci are very frequently responsible for this type of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Closed trauma of the tendon of the brachial triceps. Review of the literature. Apropos of 2 cases]

Triceps tendon closed trauma remains a rare injury. A palpable gap with impossible elbow extension against gravity is an important physical finding, and a positive "flake sign" or small avulsion fracture from the olecranon is found in the majority of patients. Trans-osseous suture gives excellent results. Partial lesions must be treated conservatively.

[Traumatic avulsion of the triceps brachialis tendon. A case report]

We report a triceps tendon avulsion (less than 40 cases reported in the medical literature). Clinical and radiological signs are: 1) Impossible elbow extension against gravity, 2) Flecks of avulsed osseous materiel from the olecranon on lateral elbow radiograph. Immediate surgical repair always produces good results.

[Osteosynthesis of forearm fractures using a P.C.D. "Small fragments" plate from A.O instruments. Apropos of 283 screwed plates]

The authors report the results of using 283 P.C.D. "petits fragments" plates by A.O. instruments, inserted between 1980 and 1989 for internal fixation of 207 forearm fractures. These included 97 double forearm fractures, 34 isolated ulnar fractures, 30 isolated radial fractures, 24 Monteggia fractures, 13 Galeazzi fractures and 9 pseudoarthroses of the radius or ulna. The mean delay to consolidation was 3.3 months with a range of 2 to 15 months. Complications included 1 hypertrophic callus of the ulna; 3 pseudoarthroses, 7 cases of sepsis (6 ulnar, 1 radius i.e. 2.5%); no plate ruptures occurred in this series. 125 plates were removed after consolidation (after 18 months); the fracture recurred in only one case where the plate was removed after 8 months. Results are based on 203 operated patients (4 lost to follow up). Before treatment of the complication, results showed 150 very good results (73.2%), 44 good results (21.5%) 1 moderate (0.5%) and 10 poor results (4.8%). After treatment of the complications there were 156 very good results (77%), 46 good results (22.5%) and 1 moderate result. In summary, forearm fractures are no longer a problem in traumatology. The P.C.D. "petits fragments" plate of A.O. instruments would appear to be particularly adapted and a bulkier implant (4.5 screw) is not required.

[Villonodular synovitis. An uncommon localization: the ankle. Apropos of a case]

The authors report an uncommon soft tissue tumor, a diffuse giant cell tumor of tendon sheath. The location is uncommon too, the ankle, behind tibial shaft and forward achilleus tendon. The primary diagnosis of ankle and leg lymphoedema, has been for a long time. But CT Scan and MRI allowing the discovery of a firm and multinodular mass, have permitted surgical excision and histological diagnosis. This case agrees with the literature review. The pigmented villonodular synovitis is rather uncommon in comparison to localized form. Young people and lower extremities are more affected; symptoms are of relatively long duration. Histological examination gives diagnosis but surgical excision has to remove the tumor completely as possible because of local recurrence rate of about 50%.

Treatment of congenital pseudarthrosis of the tibia by the Ilizarov method

Three cases of congenital pseudarthrosis were treated by the Ilizarov method. Consolidation was obtained by 3.5 months in three patients who had undergone several previous surgical procedures. Although the length of follow-up was short (maximum 3.5 years), consolidation occurred more quickly than by traditional methods. This technique also permitted both simultaneous correction of axial malalignment and leg lengthening. We think that this method has a place as a salvage procedure except where the distal fragment is very thin or dystrophic.

[Meniscal lesions in so-called "isolated" ruptures of the anterior cruciate ligament. Apropos of 59 cases]

Between December 1984 and March 1987, i.e. a period of 27 months, the authors operated on 59 "isolated" fresh ruptures of the ACL with routine evaluation of the posterior horns of the medial and lateral menisci. Lesions were investigated either by arthroscopy (23 cases) or by anterior arthrotomy with routine medial and lateral retro-ligamentous counter-incision (36 cases). This revealed 21 lesions of the medial meniscus (i.e. 35.5%) and 38 lesions of the lateral meniscus (i.e. 64.5%). Lesions of both menisci were present in 16 knees (27%) and only 16 knees (27%) were found to be free of any meniscal lesion. The majority of meniscal lesions were viable and could be sutured in 86% of cases for the medial meniscus and 87% of cases for the lateral meniscus. From the standpoint of operative technique, posterior lesions are relatively poorly visualized by arthroscopy (notably concerning the posterior horn of the medial meniscus though it is easier to assess the stability of the meniscus by this technique using the palpating hook. Lesions are well visualized by medial and lateral retroligamentous counter-incisions, but it is difficult to assess meniscus stability. Finally it should be noted that all of these ruptures of the ACL were dealt with by reconstruction of the central pivot either by suture and a strengthening procedure (semitendinous) or by ligament plasty from the outset.

[Antibiotic prevention and appendectomy. Practical consequences for health economics. Apropos of a series of 642 cases]

A total of 642 patients undergoing appendicectomy were divided into two groups of 321 patients prior to surgery. One group (A) received prophylactic antibiotic therapy, the other (B) no previous treatment. Patients were from the same region and groups were comparable for age, sex and indications for operation. Antibiotic treatment was administered according to a personal protocol based on gross appearance of appendix, and involved two molecules: Baypen in 69 cases and cephamycin (Mefoxin) in the other 252. Although not a randomized trial, the protocol was considered effective for prevention of postoperative infectious complications. In the group A, 21 patients (6.54%) developed these complications as against only 3 (0.93%) in group B, a significant difference if the total group B is considered or the two antibiotic subgroups. However, no valid conclusion can be drawn in favor of one or other of the two molecules. This effective procedure reduces by a half the duration of postoperative hospital stay for patients with a simple acute or a chronic appendicitis accepting the follow up surveillance required by the protocol. This attitude should be extended to a larger number of patients with resulting non-negligible health costs economy.

[Posterior dislocation of the hip associated with fracture of the neck of the femur. Apropos of 3 cases]

Three patients with posterior dislocation of hip associated with fracture of neck of femur were treated by early sanguineous reduction and osteosynthesis. This therapy was very effective since necrosis did not develop either in the short or long-term follow up (1, 3 and 4 years). These findings combined with documented data are in favor of anatomic reconstruction of upper end of femur by stable and solid osteosynthesis, at least in young adults. Early operation, an irreproachable operating tactic (orthopedic table, ventral decubitus, posterior approach), an immediate stable and solid synthesis and a deferred load bearing (beyond 6 months) should reduce the risk of femoral head necrosis to a minimum.

[Butel's hip screw-plate in osteosynthesis of fractures of the upper end of the femur. Apropos of 241 osteosyntheses (100 true cervical fractures and 141 fractures of the trochanter)]

Butel's hip plate was used for osteosynthesis of 241 fractures of upper end of femur (100 true cervical - 141 trochanteric and subtrochanteric fractures). Results for true cervical fractures were assessed as satisfactory in 89.5% of cases, with only 3 pseudarthroses and 4 cases of femoral head necrosis (2 septic, 2 aseptic), a total complication rate of 7.5%. These clinical results confirm the value of screw fixation at several cephalic anchorage sites (demonstrated biomechanically) in true cervical fractures. Results in trochanteric and subtrochanteric fractures were rated as satisfactory in 86.9% of cases, complications including 2 ruptures of plate, 1 sepsis and 4 early loosening of plate. The latter sequela was avoided by an improved choice of indication for the procedure and by substitution of this compound material (screw-plate) for a monobloc piece ("anti-loosening cervicocephalic screw apparatus"), in compound fractures of trochanter.

[Fractures of the lower end of the humerus in adults: influence of per- and postoperative tactics on results. Apropos of 70 osteosyntheses]

Results in 70 cases of osteosynthesis of lower end of humerus in adults were analyzed as a function of the fracture line, and the operative (approach route, type of support, attitude towards ulnar nerve transposition) and postoperative (with or without plaster immobilization) tactics. Best results were obtained in simple joint fractures (condyles, capitellum, Hahn Steinthal) with a good outcome in 89% of cases, while prognosis was poorer (68.5% of delayed good results) in more or less comminuted supra- or inter-condylar fractures (41 cases). Results are better in these latter types of fracture when an extra-articular trans-olecranon posterior approach is used. Ulnar nerve transposition was performed 43 times without adverse effects and osteosynthesis by 2 posterior screw plates (one on external and one on internal column) in 50% of cases. Valid comparison of results with or without postoperative plaster immobilization was not possible since only 8 patients were not plastered.

[Role of intermediate sealed prostheses in the treatment of fractures of the trochanter major in the elderly. Apropos of a continuous series of 110 prosthesis]

Between January 1980 and July 1983, 265 fracture of the trochanteric region in elderly patients were treated in Prof. J. Butel's department. Prior to 1980, 75% of the cases were treated with Ender's pin. However, the high failure rate of this procedure (especially in the case of complex fractures) led the authors to select the indications for this operation much more carefully. In the present series of 265 cases, there were: 110 intermediate sealed prostheses, 136 Ender's pin 19 direct osteosyntheses. At the present time (and for the last 2 years) the indications are distributed in the following way: 50% intermediate sealed prostheses, about 40% Ender's pin and 5 to 10 direct osteosyntheses. The ideal indication for intermediate sealed prosthesis is a unstable fracture of the greater trochanter (complex trochanteric fractures, fractures with a large 3rd fragment separating the lesser trochanter, trochantero-diaphyseal fractures) in autonomous elderly patients over the age of 75. This operation allows immediate weight-bearing and the operative mortality is barely more than with other techniques (21%) with very satisfactory results (more than 80 of good and very good results).

[Mammary lymphatic scintiscans by intratumoral injection in the assessment of breast cancer. 105 examination in 100 patients (author's transl)]

One hundred and five scintiscans of the mammary lymphatic system were performed in 100 patients with breast cancer by intratumoral injection of 99 m Tc-labelled colloidal rhenium. The progression of the radioactive colloidal agent was followed on a series of films taken 1, 2 and 4 hours after the injection, and the images obtained were compared with post-operative findings of lymph node involvement. Patients with more than 3 carcinomatous lymph nodes had less than 2 foci of activity, while those with less than 3 carcinomatous lymph nodes had more than 2 foci of activity, owing to more rapid progression of the compound. The difference was highly significant (p less than 0,001).