The economics of drug discovery and the ultimate valuation of pharmacotherapies in the marketplace.

Although it is commonly believed that the innovation of new medicines is of paramount importance for improving the health and quality of life of patients, there is also a keen recognition regarding upward-spiraling costs of innovation, drug discovery, and drug development against a backdrop of dwindling successes in research and development (R&D) efforts. We propose a new model of valuation of pharmacotherapies that attempts to secure an adequate return on investment in innovation by ensuring optimal pricing and reimbursement.

[Bacterial population on the site of loss of cutaneous substance. Its role on the success of skin graft]. / Population bactérienne sur une perte de substance cutanée. Son influence sur la prise des greffes.

The bacterial population of 53 skin defects was studied together with its influence on the success of split skin grafts. All of the skin defects were found to be infected. Coagulase + Staphylococcus, group A beta-haemolytic Streptococcus and Pseudomonas aeruginosa were the micro-organisms most frequently isolated. The number of microorganisms does not influence the success of the graft. Streptococcus almost always causes failure of the graft in contrast with the other microorganisms which do not appear to have any specific influence. The anti-infectious strategy must therefore be selectively directed against this microorganism.

The recognition and assessment of multiple dependencies among prospective clients at selected chemical dependency treatment programs.

Thirty-five licensed chemical dependency inpatient treatment programs were surveyed to determine (1) if these institutions recognize multiple dependencies and (2) how they assess multiple dependencies. While over 90% of the facilities recognized the existence of multiple dependencies, only 54.5% actually assessed clients for multiple dependencies. Of those institutions that attempted to assess for multiple dependencies, a total of 20 different instruments were utilized. This study indicated a widespread acceptance of multiple dependencies as a related chemical dependency problem as well as considerable uncertainty as to how to properly asses for multiple dependencies.

[The nutrient flap. Its application in saving lower limbs involved in stage IV arteritis]. / Le lambeau nourrisseur. Son application au sauvetage des membres inférieurs atteints d'artérite stade IV.

The skin covering role of the nutrient flap is only accessory. However, this role is essential for an ordinary flap. In stage IV arteriosclerosis of the lower limbs when classical revascularization techniques cannot be performed, the nutrient flap can be spread over the distal extremity of the limbs. It provides a supplementary blood flow to ischaemic zones and it induces the neoformation of a vascular network. The nutrient flap avoids the need for high amputation and preserves weight bearing by maintaining the heel. Four clinical cases are detailed and the surgical techniques are described. The flap usually raised from latissimus dorsi, is anastomosed to the popliteal artery by means of an inverted saphenous vein graft, and is spread over the extremity of the limb after a wide excision of all the necrotic tissues.

[Pseudotumoral chondrocalcinosis and carpal tunnel syndrome. Apropos of a case report]. / Chondrocalcinose pseudo-tumorale et syndrome du canal carpien. A propos d'une observation.

Review of the literature of chondrocalcinosis and rheumatologic osteoarticular causes of the carpal tunnel syndrome. Presentation of one observation of chondrocalcinosis of the wrist with presence of a pseudotumor, developed in the carpal tunnel and having induced a carpal tunnel syndrome, at first subacute, then particularly painful by direct irritation of the median nerve.

[Chronic internal metacarpophalangeal sprains of the thumb. Anatomo-clinical classification and therapeutic consequences]. / Entorses invétérées métacarpo-phalangiennes internes du pouce. Classification anatomo-clinique et conséquences thérapeutiques.

In the light of a physiopathological study of severe medial strain of the metacarpophalangeal joint of the thumb in 20 cadaver hands, the authors propose a correlation between anatomical and clinical findings and a classification derived from it: Stage I: rupture of one fascicle of the collateral ligament. Passive valgus mobility of less than 15 degrees. The ruptured ends of the ligament remain in contact. Stage II: rupture of both fascicles of the ligament. Passive valgus and supination mobility of the metacarpophalangeal joint of 20 to 40 degrees. Interposition of the dorsal digital expansion between the ruptured ends of the ligament. Abnormal movements can be corrected by applying tension to the dorsal digital expansion. Stage III: rupture of both fascicles of the collateral ligament and the dorsal digital expansion. Tension from the thenar muscles causes abnormal movement and produces a fixed flexion of the metacarpophalangeal joint with hyperextension of the interphalangeal joint (Z-shaped thumb). From this the authors determine the operative indications and suggest a palliative ligamentoplasty to restore the anatomy as much as possible.

Treatment of elbow contractures in burns.

Contractures of the elbow after burn injury are frequent and are often connected with other contractions. Surgical correction must take into consideration the topography, the likelihood of possible heterotopic ossification and the condition of the surrounding skin. A study of 66 contractures allowed us to reach the following conclusions: Linear contractures surrounded by normal skin require IC-type local flaps. Widespread contractures can be treated with thoracic flaps if healthy skin remains or else with the 'backwards flap'. Surgery on existing associated heterotopic ossification must be in two stages starting with the cutaneous step.

[Experimental study on a plaster cast in fractures of the carpal scaphoid. Clinical deductions]. / Etude expérimentale de la contention plâtrée des fractures du scaphoïde carpien. Déductions cliniques.

The displacement of the proximal and distal fragments of fractures of the carpal scaphoid have been studied in fresh cadavers. In 10 subjects, a comparison has been made between a below-elbow plaster, a moulded plaster gauntlet and an above-elbow plaster. The most satisfactory immobilisation has been obtained with a moulded plaster gauntlet incorporating the proximal phalanx of the thumb and leaving the elbow free.

Recent burns of the hand. Early excision-graft versus conventional treatment. A retrospective study during two years.

Early excision-graft of burned hands seems to have totally superseded the conventional method of progressive detorsion often with late grafting. Does this treatment merit acceptance under these conditions? Do the theoretical advantages of aggressive methods counter-balance the primary difficulty of diagnosing the initial depth of burn? Are these fewer difficulties and risks in early excision-graft than in the slower methods? Can we ascribe the failure of conventional method to a poor technical realisation? Following a short summary of the principles of the two methods, we attempt to answer these questions by a retrospective study comparing identical series of patients. We have begun a prospective randomized trial and present the preliminary results here.

Rebuilding the cervico-mandibular angle--correcting a deformity of neck burns.

Repairing the cervico-mandibular angle following neck burns is a major problem. Several artistic landmarks show its aesthetic importance. From a functional point of view, the authors show the positive consequences of rebuilding using the results from 101 patients with neck burns. In principle, the treatment involves maximal use of healthy skin, and the separate reconstruction of the horizontal and vertical parts of the neck.

[Sub-epitrochlear apophysis. A source of median nerve compression. Review of the literature]. / L'apophyse sus-épitrochléenne. Une source de compression du nerf médian. Revue de la littérature.

The supracondylar process in an osseous spur located above the medial condyle of the humerus. It may be responsible for compression of the median, as well as the ulnar, nerves. Diagnostic must be directed in this direction whenever a deficit is found in the nerve distribution territory of one of these nerves.