[Severe small bowel involvement and chronic intestinal pseudo-obstruction in systemic sclerosis (scleroderma): Pathophysiological, diagnostic and therapeutic basis, including parenteral nutrition]. / Atteinte sévère de l'intestin grêle et pseudo-obstruction intestinale chronique au cours de la sclérodermie systémique : bases physiopathologiques, diagnostiques et thérapeutiques, dont la nutrition parentérale.

Gastrointestinal involvement in systemic sclerosis can be severe, reaching the critical point of chronic intestinal pseudo-obstruction, secondary to major disorders of small bowel motility. It is associated with some clinical and biological characteristics, in particular the positivity of anti-fibrillarin/U3RNP antibodies. Chronic intestinal pseudo-obstruction (CIPO) is complicated by a small intestinal bacterial overgrowth that requires cyclic antibiotic therapy. CIPO leads to a reduction of the food intake, due to painful symptoms, nausea and vomiting caused by meals, and ultimately to severe malnutrition. Meal splitting is often transiently effective and patients require exogenous nutritional support, mostly parenteral. Systemic sclerosis is not an obstacle to initiation and long-term continuation of parenteral nutrition and central venous catheter implantation is not associated with an increased risk of cutaneous or infectious complications. However, continuation of long-term parenteral nutrition requires monitoring in an expert nutrition center in order to adapt nutritional volumes and intakes and to limit potentially fatal cardiac and hepatobiliary complications. In addition to nutrition, prokinetic treatments, whose side effects must be known, can be associated. Invasive procedures, whose risk-benefit ratio must be carefully assessed, can also be used to treat symptoms exclusively.

[Upper brachial plexus palsy. Seven cases treated by muscle transplantation (author's transl)]. / Paralysie radiculaire supérieure du plexus brachial. Traitement par transpositions musculaires associées. Résultat de sept cas.

Seven cases of upper brachial plexus palsy, have been treated by associated transplantation of pectoralis major for flexion, and of teres major and latissimus dorsi for external rotation. Operation was performed eighteen months at least after injury, during which period rehabilitation was necessary to prevent atrophy of the pectoralis major and contracture in internal rotation. The strength of flexion was improved by alterations of the original Clark's operation. The whole muscle was transplanted: its humeral tendon was fixed to the coracoid process; its thoracic extremity lengthened by an aponevrotic flap from rectus anterior was pulled through a posterior anti-brachial incision, holding the arm in anteposition and the forearm in supination. A strong tension was obtained in this way. Transplantation of teres major and latissimus dorsi tendons behind the humerus was done in the same stage. Results are in favor of these improvements: all seven patients, including two hard-workers, obtained a strong and large flexion. The useful part of external rotation was restored. All went back to their former occupations.