Impact on facial skin aging signs of a 1-year standardized photoprotection over a classical skin care routine in skin phototypes II-VI individuals: A prospective randomized trial.

BACKGROUND: Data reflecting the impact of photoprotection on cutaneous aging are scarce and mostly limited to fair skin. OBJECTIVE: To assess the effectiveness of a photoprotective product in counteracting the photoaging process in different skin phototypes over 1 year compared against a classical routine. MATERIALS AND METHODS: Two hundred and ninety Brazilian women aged 30-65 years, with skin phototype II-VI were equally randomized in two groups. Group 1 kept on their routine whereas Group 2 applied, twice daily, a photoprotective product (SPF 60, PPD = 24.1) replacing the one they routinely used. Volunteers reported the duration of their daily sun-exposure. Standardized photographs taken at D0 and D365 were analysed by 15 dermatologists to assess eight wrinkles and pigmentation signs. RESULTS: A global increase in severity was reported which was significant for Group 1. This increase was lower in Group 2 where only half the signs showed significant worsening. In Group 2 versus Group 1, the increase in forehead wrinkles, marionette lines, wrinkles created by ptosis and size of dark spot was significantly (p < 0.05) decreased by 30%-50%. CONCLUSION: Daily application of a high photoprotective product significantly decreases the progression of skin aging signs after 1 year in skin phototypes II-VI.

Artificial Intelligence analysis of over half a million European and Chinese women reveals striking differences in the facial skin ageing process.

BACKGROUND: Artificial Intelligence (A.I) and deep learning-based algorithms are increasingly being used in dermatology following the emergence of powerful smartphones with high-resolution cameras. OBJECTIVES: To use an A.I-based algorithm, validated by dermatologists, to compare the evolution of the skin ageing process among Chinese and European women. METHODS: Selfie images were taken by 465 587 European and 79 016 Chinese women ranging from 18 to 85 and 18 to 69 years old, respectively, without facial skin diseases and who had access to a smartphone with a high-resolution camera (≥4 Megapixels). The selfies were analysed by facial skin diagnostic using a smartphone application to grade the severity of 9 facial signs (including wrinkles, sagging, vascular, pigmentation signs, pores). RESULTS: Wrinkles/texture, ptosis and sagging increased linearly with age in European women compared to lower scores and more gradual increase in the younger age-classes in Chinese women. In Chinese women, pigmentation signs increased regularly between 18 and 40 years, plateaued between 40 and 60 years, then increased in the over 60s compared to lower scores and a slower more regular increase with age in European women. Vascularization signs increased steadily with age in European women compared to no significant change in Chinese women. CONCLUSIONS: Marked differences were observed in the skin ageing process between European and Chinese populations, both in the prevalence of each facial ageing sign and their kinetics. Automatic grading performed on selfies and analysed by A.I is a fast and confidential method for quantifying signs of facial ageing and identifying the main issues for each population and age-class, which is of practical interest, as it will allow the development of tailored prevention and therapeutic measures.

Clinical impacts of sun exposures on the faces and hands of Japanese women of different ages.

OBJECTIVE: To assess the impacts of sun exposures on some skin signs on the faces and hands of differently aged Japanese women, according to their distinct behaviours towards vis à vis sun exposure. METHODS: Two comparable cohorts of Japanese women (aged 18-83 years) were created according to their usual behaviour towards sun exposure i.e. non-sun-phobic (N = 495) and sun-phobic (N = 516) and through their regular use(s) of a photo-protective product. Standard photographs (full-face and 45° lateral) allowed to focus on 18 facial signs that were graded by 15 experts, using a referential skin ageing Atlas. From these two cohorts, two sub-cohorts (114 and 122 women) were created with regard to the similar clinical aspects of the dorsal side of their hands (Left vs. Right) that were further graded. Absolute differences in the scores of each sign were used (non-sun-phobic minus sun-phobic), by age-ranges, to better ascertain the impact of sun exposures and photo-protection. RESULTS: Facial signs related to skin wrinkles/texture and pigmentary spots were found significantly more accentuated among non-sun-phobic women and show an early onset (20-30 years). Facial sagging and crow's feet wrinkles appear delayed (30-40 years). The severity of vascular disorders was found to be similar in the two cohorts. The absolute differences in the grading's of almost all signs were unsurprisingly found increased with advancing ages, illustrating the combination of chronological and photo-ageing processes. With regard to hands, differences in skin texture and pigmentary disorders are of a late onset (40-50 years) and were found much increased at older ages. The cutaneous signs of the hands of Japanese women can hardly be taken as reliable markers of their photo-ageing status. CONCLUSION: The present work illustrates, for the first time, some specificities of the impact of sun exposures on the facial skin of Japanese women, pinpointing the fact that some facial signs are of an early onset. Results significantly confirm the importance of both sun avoidance coupled with photo-protective measures.

OBJECTIF: D'évaluer les impacts de l'exposition solaire sur plusieurs signes du visage et des mains de femmes Japonaises d'âge différents, selon leurs différents comportements vis-à-vis de l'exposition solaire. MÉTHODES: Deux cohortes comparables de femmes Japonaises (âgées de 18 à 83 ans) ont été créées selon leur comportement habituel vis à vis de l'exposition solaire, phobique (N = 516) ou non (N = 495) et selon leur utilisation(s) régulière(s) de produits photo-protecteurs. Des photographies standardisées du visage de face et latérales (45°) ont permis de se focaliser sur 18 signes cliniques du visage dont la sévérité a été quantifiée par 15 experts, utilisant un Atlas de référence du vieillissement cutané. De ces deux cohortes, deux sous-cohortes ont été extraites (114 et 122 femmes) par les aspects cliniques similaires de la face dorsale de leurs mains (Gauche vs. Droite) pour être ensuite quantifiées. Les différences absolues de chaque signe (non-phobiques moins phobiques), par tranches d'âges, ont été utilisées pour mieux déterminer l'impact des expositions solaires et des routines de photo-protection. RÉSULTATS: Les signes du visage liés à la texture cutanée/rides et aux taches pigmentaires ont été trouvés significativement aggravés chez les femmes non-phobiques de l'exposition solaire et d'apparition précoce (20-30 ans) tandis que la ptose du visage ou les rides de la patte d'oie apparaissent plus tardivement (30-40 ans). La sévérité des désordres vasculaires du visage a été trouvée similaire dans les deux cohortes. Les différences absolues dans la sévérité de la plupart des signes ont été logiquement trouvées accrues avec l'âge, illustrant la combinaison du vieillissement chronologique et de celui photo-induit. Concernant les mains, les différences dans la texture cutanée et les désordres pigmentaires apparaissent significativement tardives (40-50 ans) et augmentent à des âges plus avancés. Les signes cutanés des mains des femmes Japonaises ne semblent donc pas être des marqueurs fiables du vieillissement photo-induit. CONCLUSION: La présente étude illustre, pour la première fois, quelques spécificités des impacts de l'exposition solaire sur les signes faciaux de femmes Japonaises, pointant le fait que certains sont d'apparition précoce. Les résultats confirment de manière significative l'importance d'éviter les expositions solaires et de recourir à des mesures photo-protectrices.

Schnitzler syndrome: validation and applicability of diagnostic criteria in real-life patients.

BACKGROUND: Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, and clinical, histological, and biological signs of neutrophil-mediated inflammation. The aim of this study was to assess the applicability and validity of the existing diagnostic criteria in real-life patients. METHODS: This multicentric study was conducted between 2009 and 2014 in 14 hospitals in which patients with Schnitzler syndrome or controls with related disorders were followed up. We compared the sensitivities and specificities and calculated the positive and negative predictive values of the Lipsker and of the Strasbourg criteria for the patients with Schnitzler syndrome and for the controls. We included 42 patients with Schnitzler syndrome, 12 with adult-onset Still's disease, 7 with cryopyrin-associated periodic disease, 9 with Waldenström disease, and 10 with chronic spontaneous urticaria. RESULTS: All patients with Schnitzler syndrome met the Lipsker criteria. According to the Strasbourg criteria, 34 patients had definite Schnitzler syndrome, five had probable Schnitzler syndrome, and three did not meet the criteria. One control met the Lipsker criteria and had probable Schnitzler syndrome according to the Strasbourg criteria. Sensitivity and specificity of the Lipsker criteria were 100% and 97%, respectively. For the Strasbourg criteria, sensitivity for definite and probable diagnosis was 81% and 93%, respectively, with a corresponding specificity of 100% and 97%. CONCLUSION: Diagnostic criteria currently in use to diagnose Schnitzler syndrome are reliable. More investigations must be done to attest their efficiency in patients with recent-onset manifestations.

A new bunya-like virus associated with mass mortality of white-clawed crayfish in the wild.

We report the discovery of a new enveloped, spherical virus belonging to the Phenuiviridae family of negative ssRNA viruses associated with a massive outbreak in a French population of the endangered white-clawed crayfish Austropotamobius pallipes. We call this virus Bunya-like Brown Spot Virus (BBSV) and characterize it using transmission electronic microscopy, genome sequencing and clinical signs. Infected specimens show discolored brown spots on the cuticle. Using RNA-seq data we assembled a partial sequence for the L, M and S genome segments of BBSV. Phylogenetic analyses using all three segments show this virus is closely related to the Wenling crustacean virus 7 (China) and to a bunya-like virus found in feces of the European otter. Our survey of the mass mortality event indicates the virus is less virulent than the crayfish plague caused by Aphanomyces astaci. Overall, the discovery of BBSV provides a new important asset to monitor A. pallipes populations.

Concomitant association of giant cell arteritis and malignancy: a multicenter retrospective case-control study.

INTRODUCTION: Some studies suggest that there is an increased risk of malignancies in giant cell arteritis (GCA). We aimed to describe the clinical characteristics and outcomes of GCA patients with concomitant malignancy and compare them to a GCA control group. METHOD: Patients with a diagnosis of GCA and malignancy and with a maximal delay of 12 months between both diagnoses were retrospectively included in this study and compared to a control group of age-matched (3:1) patients from a multicenter cohort of GCA patients. RESULTS: Forty-nine observations were collected (median age 76 years). Malignancies comprised 33 (67%) solid neoplasms and 16 (33%) clonal hematologic disorders. No over-representation of a particular type of malignancy was observed. Diagnosis of GCA and malignancy was synchronous in 7 (14%) patients, while malignancy succeeded GCA in 29 (59%) patients. Malignancy was fortuitously diagnosed based on abnormalities observed in laboratory tests in 26 patients, based on imaging in 14 patients, and based on symptoms or clinical examination in the nine remaining patients. Two patients had a concomitant relapse of both conditions. When compared to the control group, patients with concomitant GCA and malignancy were more frequently male (p < 0.001), with an altered general state (p < 0.001), and polymyalgia rheumatica (p < 0.01). CONCLUSIONS: This study does not indicate an over-representation of any particular type of malignancy in GCA patients. Initial follow-up dictated by vasculitis may have led to an early identification of malignancy. Nevertheless, GCA male patients with an altered general state and polymyalgia rheumatica might more frequently show concomitant malignancies.

Can the presence of an infection be predicted before a revision total hip arthroplasty? Preliminary study to establish an infection score.

INTRODUCTION: The diagnosis of periprosthetic joint infection can be challenging, in part because there is no universal diagnostic test. Current recommendations include several diagnostic criteria, and are mainly based on the results of deep microbiological samples; however, these only provide a diagnosis after surgery. A predictive infection score would improve the management of revision arthroplasty cases. The purpose of this study was to define a composite infection score using standard clinical, radiological and laboratory data that can be used to predict whether an infection is present before a total hip arthroplasty (THA) revision procedure. HYPOTHESIS: The infection score will make it possible to differentiate correctly between infected and non-infected patients in 75% of cases. MATERIAL AND METHODS: One hundred and four records from patients who underwent THA revision for any reason were analysed retrospectively: 43 with infection and 61 without infection. There were 54 men and 50 women with an average age of 70±12 years (range 30-90). A univariate analysis was performed to look for individual discriminating factors between the data in the medical records of infected and non-infected patients. A multivariate analysis subsequently integrated these factors together. A composite score was defined and its diagnostic effectiveness was evaluated as the percentage of correctly classified records, along with its sensitivity and specificity. RESULTS: The score consisted of the following individually weighed factors: body mass index, presence of diabetes, mechanical complication, wound healing disturbance and fever. This composite infection score was able to distinguish correctly between the infected patients (positive score) and non-infected patients (negative score) in 78% of cases; the sensitivity was 57% and the specificity 93%. DISCUSSION: Once this score is evaluated prospectively, it could be an important tool for defining the medical - surgical strategy during THA revision, no matter the reason for revision. LEVEL OF EVIDENCE: Level IV - retrospective study.

Mesenchymal stem cells rescue CD34+ cells from radiation-induced apoptosis and sustain hematopoietic reconstitution after coculture and cografting in lethally irradiated baboons: is autologous stem cell therapy in nuclear accident settings hype or reality?

Autologous stem cell therapy (ACT) has been proposed to prevent irradiated victims from bone marrow (BM) aplasia by grafting hematopoietic stem and progenitor cells (HSPCs) collected early after damage, provided that a functional graft of sufficient size could be produced ex vivo. To address this issue, we set up a baboon model of cell therapy in which autologous peripheral blood HSPCs collected before lethal total body irradiation were irradiated in vitro (2.5 Gy, D0 1 Gy) to mimic the cell damage, cultured in small numbers for a week in a serum-free medium in the presence of antiapoptotic cytokines and mesenchymal stem cells (MSCs) and then cografted. Our study shows that baboons cografted with expanded cells issued from 0.75 and 1 x 10(6)/kg irradiated CD34+ cells and MSCs (n=2) exhibited a stable long-term multilineage engraftment. Hematopoietic recovery became uncertain when reducing the CD34+ cell input (0.4 x 10(6)/kg CD34+ cells; n=3). However, platelet recovery was accelerated in all surviving cografted animals, when compared with baboons transplanted with unirradiated, unmanipulated CD34+ cells (0.5-1 x 10(6)/kg, n=4). Baboons grafted with MSCs alone (n=3) did not recover. In all cases, the nonhematopoietic toxicity remained huge. This baboon study suggests that ACT feasibility is limited.

Incidence of hematological malignancies in Martinique, French West Indies, overrepresentation of multiple myeloma and adult T cell leukemia/lymphoma.

A registry of hematological malignancies is held in the unit of cytology of the University Hospital of Martinique. Human T cell lymphotropic virus type-1 (HTLV1) is endemic in this island. We determined the incidence and epidemiological features of hematological malignancies from the 715 new cases diagnosed between 1990 and 1998 among the adult population. Incidence rates per year were steady during this period. The most frequent hematological malignancies were multiple myeloma (MM) (34%), followed by non-Hodgkin's lymphoma (NHL) (23%). Among the cases of NHL with an immunohistological study, 57% had a T cell phenotype. Among these 61% were adult T cell leukemia/lymphoma. Epidemiological data on hematological malignancies in the West Indies has not been previously reported. There are two striking differences with other population-based registries: a high incidence of MM (5/100000) and a high proportion of T cell NHL among NHL (57%). The high proportion of T cell NHL is probably due to the high incidence of ATL. A low incidence of B cell NHL might also contribute to this effect. The increased incidence of MM in West Indies had not been previously reported. A similar high incidence of MM has been reported among Afro-Americans in the USA.

[Can metal-on-metal bearings improve the longevity of total hip prostheses?]. / Un couple de frottement métal-métal peut-il améliorer la longévité des prothèses totales de hanche?

PURPOSE OF THE STUDY: In total hip arthroplasty (THA), inter-series comparative clinical results cannot be considered worthy before at least 10 years of average follow-up, as shown in the Swedish Arthroplasty Register experience (1978-1993). Last generation metal-on-metal bearings were introduced in France only nine years ago (1995). To date, using mid term information, data from the literature, and our experience, one could assume that this bearing material has the capacity to improve THA longevity. Three types of information were analyzed: 1) comparative radiographic and EBRA studies published on early migration (<2 years) of acetabular implants; 2) preliminary comparative data on wear and osteolysis at the 8-year maximum follow-up; 3) clinical data on dislocation frequency and in vitro and in vivo observations of bearing separation and sliding. Study no 1: primary stability of these metal-on-metal acetabular cups was better than for polyethylene (PE) cups or alumina liners; study no 2: no detectable wear and less osteolysis were observed to date with metal-on-metal bearings versus their alumina-on-PE counterparts. Study no 3: less dislocation and less head sliding were measured with the metal-on-metal versus alumina-on-PR bearings possibly due to the interfacial forces provided by lubricating fluid (suction fit). CONCLUSION: According to current knowledge, this metal-on-metal bearing still represent, with alumina-on-alumina and highly crosslinked PE, a competitive and comprehensive option to improve THA longevity. The real pending problem concerns the frequency and above all the intensity of metal delayed hypersensitivity reaction and their potential effect on implant loosening.

Registries in orthopaedics.

The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established registries, with varying degrees of success. Managing a registry requires time and money. Factors that contribute to successful registry management include the use of a single identifier for each patient to ensure full traceability of all procedures related to a given implant; a long-term funding source; a contemporary, rapid, Internet-based data collection method; and the collection of exhaustive data, at least for innovative implants. The effects of registries on practice patterns should be evaluated. The high cost of registries raises issues of independence and content ownership. Scandinavian countries have been maintaining orthopaedic registries for nearly four decades (since 1975). The first English-language orthopaedic registry was not created until 1998 (in New Zealand), and both the US and many European countries are still struggling to establish orthopaedic registries. To date, there are 11 registered nationwide registries on total knee and total hip replacement. The data they contain are often consistent, although contradictions occur in some cases due to major variations in cultural and market factors. The future of registries will depend on the willingness of health authorities and healthcare professionals to support the creation and maintenance of these tools. Surgeons feel that registries should serve merely to compare implants. Health authorities, in contrast, have a strong interest in practice patterns and healthcare institution performances. Striking a balance between these objectives should allow advances in registry development in the near future.

Bioartificial pancreas containing porcine islets of Langerhans implanted in low-dose streptozotocin-induced diabetic mice: effect of encapsulation medium.

Two encapsulation culture media without animal serum were compared for development of a bioartificial pancreas. Porcine islets were suspended in Hams F10 medium supplemented with 2% Ultroser (US) or in Ultraculture medium (UC) and encapsulated in hollow fibres composed of AN69 copolymer. The function of encapsulated islets was assessed by intraperitoneal transplantation of two fibres in streptozotocin-induced diabetic mice. In both groups of transplanted mice (US, n = 26; UC, n = 18), a significant decrease in plasma glucose concentration was observed three days after fibre implantation (from 21.9 +/- to 14.4 +/- 0.8 mmol/l for US fibres and from 22.7 +/- 0.8 to 13.3 +/- 1.3 mmol/l for US fibres and from 22.7 +/- 0.8 to 13.3 +/- 1.3 mmol/l for UC fibres). Graft survival 17 days after implantation was 61% for mice with UC fibres and 35% for those with US fibres (P = 0.0001). Intramuscular glucose tolerance tests were performed in these animals (US, n = 5; UC, n = 10), and a normal glucose pattern was observed in both groups of transplanted mice. The results show that a complete normalisation of blood glucose and glucose tolerance can be achieved by implantation of a bioartificial pancreas. Moreover, UC appears to be a more suitable encapsulation culture medium for porcine islets in vivo.

The prevalence of diabetes mellitus in the adult population of Guadeloupe as estimated by history or fasting hyperglycemia.

A study was conducted between January 1984 and March 1985 to determine the prevalence of diabetes in the adult population of Guadeloupe (18 years of age and over). A two-step sampling frame, using a sampling fraction of 0.46%, where the primary units were composed of districts and where sub-units were households, was used. The household refusal rate was 22%. Subjects were classified as 'diabetic' when they were either already known or when their fasting plasma glucose was above 8.0 mmol/l. The total age and sex standardized prevalence of diabetes among the adult population of Guadeloupe can be estimated at 6.6%. The high prevalence rate appears to be related to obesity (strongly in women), a genetic susceptibility (22.5% of age standardized prevalence among subjects of Asian Indian origin for both sexes), and, possibly, in men of African origin only, to a maternal history of diabetes.

Survival analysis of cementless grit-blasted titanium total hip arthroplasties.

Although about 200000 cementless Zweymüller-Alloclassic total hip arthroplasties (THAs) were carried out worldwide in the last decade, the survival analysis of these prostheses was not available in the 2000 report of the Swedish national hip arthroplasty registry. We report a prospective survivorship analysis of 200 consecutive grit-blasted cementless Alloclassic primary THAs carried out since 1988. Using surgical, clinical and radiological endpoints for the stem and the threaded cup the ten-year survivorship was 91.5% for reoperation for any cause, 96.4% for hip pain (Merle d'Aubigné score < 5 points, clinical failure), 99.4% for definite aseptic loosening (radiological failure) and 99.3% for revision for aseptic loosening. Using the Swedish registry criteria of primary osteoarthritis and revision for aseptic loosening as the endpoint, the survival rate of 99.1% at ten years for the subgroup of 157 Alloclassic THAs in osteoarthritis compares favourably with that of the best modern cemented hip replacements reported in the Swedish arthroplasty registry.

Osteopenia in patients infected by the human immunodeficiency virus. A case control study.

Summary - In the last few years, the use of highly active antiretroviral therapy has radically modified the prognosis of human immunodeficiency virus (HIV) infection. Osteonecrosis and osteoporosis are among the bone complications recently described in HIV-infected patients. We report a preliminary study comparing 47 HIV-infected patients (31 men and 16 women) to 47 age- and sex-matched controls. Bone mineral density was lower in patients than in controls: in men, 0.919 +/- 0.120 g/cm2 vs. 1.010 +/- 0.139 g/cm2 (P = 0.01) at the total hip and 0.948 +/- 0.100 g/cm2 vs. 1.043 +/- 0.117 g/cm2 (P = 0.0008) at the lumbar spine; in women, 0.912 +/- 0.149 g/cm2 vs. 0.968 +/- 0.090 g/cm2 at the total hip (P = 0.17) and 0.989 +/- 0.152 g/cm2 vs. 1.080 +/- 0.097 g/cm2 (P = 0.01) at the lumbar spine. HIV-infected males were more likely to have osteopenia and osteoporosis, as compared to the male controls (19 vs. 14 and 4 vs. 1, respectively, P = 0.02). None of the women had osteoporosis; nine HIV-infected women and one female control had osteopenia (P = 0.003). No fractures were recorded. In this preliminary study, no evidence supporting a relationship between bone loss and protease inhibitor treatment was found.

[Intestinal angiostrongyliasis caused by Angiostrongylus costaricencis. Apropos of a case in Martinique]. / Angiostrongylose intestinale à Angiostrongylus costaricensis. A propos d'un cas en Martinique.

Intestinal angiostrongyliasis caused by Angiostrongylus costaricensis is a rare nematodiasis which is present mainly in Costa-Rica, and in some other countries in the northern part of South America, Central America, and in the southern part of Mexico. This is a report of the first case from Martinique involving a sixteen month old child, and proved by an intestinal pathologic study. The epidemiology of the disease, its clinical, parasitological, histopathologic and therapeutic aspects are emphasized.

[Extrapulmonary tuberculosis in the central western region. Retrospective study of 217 cases (Gericco 1991-1993)]. / Tuberculose extrapulmonaire dans la région centre-ouest. Etude rétrospective de 217 cas (Gericco 1991-1993).

OBJECTIVES: To analyze the epidemiological, clinical and diagnostic characteristics of extrapulmonary tuberculosis in western France observed from 1991 to 1993 in different patients populations (HIV+ infected patients, immunosuppressed non-HIV infected patients, non-immunosuppressed patients) and according to various localizations (lymph nodes, bone and joints, genital organs, nervous system and meninges, miliary disease). METHODS: This retrospective study included 217 cases of extrapulmonary tuberculosis diagnosed from 1991 to 1993 in western France by GERICCO (Groupe d'Epidémiologie et de Recherche en Infectiologie Clinique du Centre-Ouest). Demographic, clinical, biological, microbiological and radiographic characteristics as well as clinical course on specific therapy were assessed. RESULTS: Extrapulmonary tuberculosis generally occurred most often in immunosuppressed patients but 34% of cases were observed in people without any underlying disease or risk factors. Delay to diagnosis was especially long in the non-immunosuppressed patients (mean = 96 days) but shorter in the HIV-infected patients (mean = 59 days). It was shorter in case of nervous system involvement (mean = 52 days) or military disease (mean = 80 days) than in bone and joints (mean = 120 days) and lymph nodes (mean = 102 days). Microbiologically proven tuberculosis represented only 75% of cases despite numerous investigations. Overall prognosis was good except in nervous system and meninges localizations. Failures were mainly due to death in immunosuppressed patients. CONCLUSION: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. In 50% of cases, confirmation of diagnosis takes more than one month. In case of doubt, clinicians should not wait for laboratory results before implementing empirical specific therapy.

[Second-generation metal bearings in cementless primary total hip arthroplasty: rationale, French homologation and preliminary results]. / Couple de friction métallique de seconde génération en arthroplastie totale primaire non cimentée de hanche. Justification, homologation française et résultats préliminaires.

PURPOSE OF THE STUDY: Long-term outcome of Charnley low-friction arthroplasty in young active patients is impaired worldwide due to wear of the polyethylene (PE) component and osteolysis. In the late eighties, reports of possible low wear with some former metal on metal total hip arthroplasties led to the reintroduction of metallic bearings. The aims of this work were to examine the rationale for using metal on metal bearings in primary total hip arthroplasty (THA) and report preliminary results obtained with cementless Metasul -Alloclassic hips. MATERIALS AND METHODS: From January 1994 to March 1997, 64 cementless primary Alloclassic-THA (grit-blasted titanium SL stems and CSF treaded cups) with 28 mm Metasul bearings were performed. Mean age at surgery was 60 years (range, 36-73). Diagnoses were usual, mainly primary osteoarthrosis in 70 p. 100 of the hips. Two bearing surfaces were exchanged for late dislocation at 2.6 and 2.9 years. Thus, 62 hips in 58 active patients (4 bilateral) were reviewed after a minimum 2-year follow-up (mean 3.2 years, range 24-66 months). RESULTS: Clinical results according to the Merle d'Aubigne and Charnley rating system were graded excellent or good in all 62 hips. Radiologically, calcar, atrophy and spot welds were noted in 93 p. 100 and 82 p. 100 of hips respectively. Proximal reactive and lucent lines and mild proximal stress shielding were observed in 8 p. 100 and 4.8 p. 100 of hips respectively. No osteolysis granuloma has thus far been observed in the vicinity of any component. Cobalt blood level remained normal, except in 6 cases due to occupational exposure (n=1), possible impingement (n=1) or an unknown cause (n=4). All elevated cobalt levels (range 7 to 25 microg/l) were nevertheless far below the toxic limit. DISCUSSION: Dislocation may be due either to the posterolateral surgical approach and/or early impingement with the first Metasul bearing design (head sleeve). Metasul acetabular component fixation is not restricted to only cementless metal-backing, unlike alumina-ceramic cups. The concern about the toxicity of metallic wear debris dissemination and the hematocarcinogenic risk must be taken into consideration as for any metallic THA. Follow-up is too short for the new polys for significant comparisons. CONCLUSION: Metal on metal tribology is well known in vitro and Metasul bearings have functioned in vivo for 12 years (120 000 Metasul hips worldwide) as was expected from laboratory tests. Obviously, this friction couple is not the unique answer to PE-wear and THA longevity, but, in light of current data, appears as a trustworthy solution available today.

[Arthroscopic assessment and clinical correlation of femoro-patellar tracking. Apropos of 116 knees in 115 patients under 40]. / Evaluation arthroscopique du recentrage fémoro-patellaire et corrélation clinique. A propos de 116 genoux chez 115 patients de moins de 40 ans.

PURPOSE OF THE STUDY: The dynamic study of the patello-femoral joint is of outstanding interest in unexplained anterior knee pain syndrome. Accuracy of information provided by video-arthroscopy is of concern due to its technical conditions. Serum inflow favors the natural patellar tendency to shift laterally (mean value, 7 degrees ). Absence of active quadriceps muscle contraction under anesthesia and use of a tourniquet act conversely. The aim of this study conducted in less than 40 year-old patients, was to correlate retrospectively arthroscopic evaluation of patello-femoral tracking and trochlear centralization measured during conventional "inflow" procedure, with patella related pain syndrome and its outcome. MATERIAL AND METHODS: The study group included 116 knees in 66 male and 49 female patients (1 bilateral). Mean age at arthroscopy was 26 years (range, 12 to 40 years). According to pre-arthroscopic clinical data, knees were broken down into 3 study groups: Gr-T (Test, painless patella), 50 knees with meniscal and/or ligament injury: Gr-PRP (Patella Related Pain but no dislocation), 55 knees: Gr-DLC (patella DisLoCation), 11 knees. Arthroscopic technique was the following: general anesthesia, high-proximal pneumatic tourniquet (40mmHg), single antero-lateral portal and serum inflow by simple gravity (2m). The minimum flexion angle that was necessary to obtain de visu a perfect centralization of the patella dome into the trochlear groove was systematically measured before any arthroscopic procedure was performed. RESULTS: Average value of the Flexion Angle providing perfect Centralization (FAC) in the "serum inflow" arthroscopic situation was 39 degrees in Gr-T and 52 degrees in Gr-PRP; this difference was highly significant (p <.0001). Patella centralization could not be achieved despite maximum possible flexion in 5 of the 55 PRP-knees and in 9 of the 11 DLC-knees. FAC value > 65 degrees correlated significantly (chi2, p=0.0001) with patella related clinical symptoms (pain and instability, groups PRP + DLC) and indicated patellar maltracking. In the PRP-group, an "FAC value > 65 degrees" showed a low sensitivity (0.34), but high specificity and positive predictive value of 0.98 and 0.95, respectively. DISCUSSION AND CONCLUSION: Arthroscopic examination for patello-femoral tracking can provide measurable information on the FAC angle, that is reproducible under precise technical conditions. Its diagnostic value in unexplained anterior knee pain versus information provided by conventional imaging, and their respective effectiveness-risk and -cost relations could be the purpose of future prospective studies.

[Effect of arthroscopic fluid inflow on the femoro-patellar tracking. Comparative study of the dry and fluid filled knee]. / Effet du remplissage liquidien arthroscopique sur l'engagement fémoro-patellaire. Etude comparative du genou sec et liquidien.

INTRODUCTION: The dynamic study of the patello-femoral joint is of outstanding interest in unexplained anterior knee pain syndrome. Nevertheless, the accuracy of information regarding this particular point by means of video-arthroscopy is of concern, due to the surgical conditions of the procedure. The aim of this study was to appreciate the effect of serum inflow on the visual evaluation of the patello-femoral tracking during conventional knee arthroscopy. MATERIAL AND METHODS: The study group included 100 knees in 68 male and 32 female patients. Mean age at surgery was 36 years (range, 13 to 69 years). Indication for knee arthroscopy was: meniscal and/or ligament injury in 77 knees (group I), patello-femoral pain in 13 knees (group II), tibial tuberosity screw removal in 7 knees (group III) and "mysterious" painful knee in 3 patients (group IV). Arthroscopic technique was conventional; general anaesthesia, pneumatic tourniquet, single antero-lateral portal and serum inflow by simple gravity. We measured the minimum flexion angle that was necessary to obtain de visu a perfect centralization of the patella dome into the trochlear groove in two situations: before inflating the knee ("dry" angle) and after serum inflow ("serum" angle). RESULTS: The average value of the flexion angle providing perfect centralization (FAC) in the "dry" situation and in the "serum" situation was 31 degrees (range, 10 to 75 degrees) and 38 degrees (range, 20 to 85 degrees), respectively. Of the 100 studied knees, the average difference between the "serum" and the "dry" FAC was about 7 degrees (6 degrees 45', standard deviation: 3 degrees 56') and was superior to 10 degrees in only one occasion; this difference is significative (T-test; p < 0.0001). Conversely, there was no significant difference between the average differential FAC figure noted in each group of patients (ANOVA; p = 0.28). DISCUSSION: The role, if any, of the tourniquet inflated around the proximal thigh is more or less constrictive, thus restricting the natural patellar tendency to shift laterally. Moreover, the absence of active quadriceps muscle contraction under general anaesthesia acts also in the same way. CONCLUSION: By comparison with the more natural "dry" situation, in nearly all occasions serum inflow by simple gravity induced less than 10 degrees of knee flexion overcourse until the obtention of a perfect patello-trochlear centralization. This data must be taken to consideration during arthroscopic examination of the patello-femoral tracking in the diagnosis of anterior knee pain that would remain unexplained after conventional imaging procedures.