Asymmetric pelvis and term breech presentation: is planned vaginal delivery still a safe option?

PURPOSE: To evaluate the obstetrical prognosis of term breech delivery in case of asymmetric pelvis. METHODS: An observational, comparative, retrospective, bi-centric study of 559 patients who had a computer tomography pelvimetry prior to delivery of a term breech presentation was conducted between August 2013 and August 2019. Patients with an attempted vaginal delivery were divided into two groups: a group of asymmetric pelvis (AP) when the difference between the lengths of both oblique diameters was ≥ 1 cm and a group of symmetric pelvis (SP) when the two oblique diameters differed by < 1 cm. The primary outcome was the rate of vaginal delivery. Secondary outcomes were a composite variable of neonatal and maternal morbidity and mortality. RESULTS: Of the 370 patients who attempted a vaginal breech delivery, 8% (n = 29) had an AP and 92% (n = 341) had a SP. In the AP group, the vaginal delivery rate was higher (93% versus 78%, p = 0.05). There was no statistically significant difference in neonatal (3% versus 1% in the AP and SP groups, respectively, p = 0.4) and maternal (17% versus 23% in the AP and SP groups, respectively, p = 0.5) morbidity and mortality. CONCLUSION: When a pelvimetry is performed before an attempt of vaginal breech delivery, a difference of less than two centimetres between both oblique diameters does not seem to reduce the rate of vaginal birth and is not an indication for an elective caesarean section.

Two-dimensional and shear wave elastography ultrasound: A reliable method to analyse spastic muscles?

INTRODUCTION: Few data exist on the feasibility and reliability of measuring muscular atrophy in 2 dimensions (2D) by ultrasonography (US) and elasticity with shear wave elastography (SWE) in spastic muscles. METHODS: Fourteen patients with chronic stroke took part in 2 intersession reliability experiments performed with 1-week intervals between sessions. Pennation angle (PA), muscle thickness (MT), and shear elastic modulus (µ) were measured in spastic gastrocnemius medialis (GM) muscles at rest and at maximal passive stretching in paretic and nonparetic legs. RESULTS: On the paretic side, the coefficient of variation (CV) in GM was 6.30% for MT and 6.40% for PA at rest and was 7.53% and 8.26% for MT and PA, respectively, at maximal passive stretching. The reliability of the µ measurement was good only for GM at rest on the paretic side (CV = 9.86%). DISCUSSION: 2D US associated with SWE shows promise for assessing structural changes in muscles. With some methodological adaptations, this approach could help guide spasticity treatment. Muscle Nerve 57: 222-228, 2018.

[Evaluation of the management of soft tissue sarcomas in Franche-Comté since the establishment of a multidisciplinary meeting at University Hospital. About 47 cases]. / Évaluation de la prise en charge des sarcomes des tissus mous en Franche-Comté depuis l'instauration d'une réunion de concertation pluridisciplinaire au CHRU. À propos de 47 cas.

GOALS OF STUDY: A multidisciplinary meeting (RCP) dedicated to the treatment of sarcoma was established in Franche-Comte in 2010. The goals of the study are: (a) To evaluate the treatment of sarcomas by confrontation with the existing literature; (b) To evaluate the influence of the multidisciplinary meeting on the management of sarcomas by hospitals at the regional level. MATERIALS AND METHODS: This is a retrospective single center study from 2010 to 2015 on patients with sarcoma and peripheral soft tissue drawn from a Netsarc database (National Network of sarcomas) and communicating cancer record. A database Cleanweb especially dedicated is created. RESULTS: Forty-seven patients were included: ten sarcomas at the upper member 26 to the lower limbs, 11 on the trunk. Forty patients were operated on: ten out of the university hospital, 28 at the university hospital and two in a coordinating center. Ninety percent of patients treated at the university hospital were in accordance with the recommandations. None of the patients operated out of the university hospital benefited from medical care in accordance to the recommendations. There is an increase in the number of files sent by the hospitals out of the university hospital discussed in multidisciplinary meeting, before treatment. CONCLUSION: The creation of a dedicated multidisciplinary meeting sarcoma improves the medical management of these tumors and decreases inappropriate medical managements thanks to a better education of the regional physicians.

Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors.

INTRODUCTION: Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. MATERIALS AND METHODS: Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. RESULTS: Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. DISCUSSION: This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. CONCLUSION: The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.

[HTLV and "donating" milk]. / HTLV-1 et don de lait maternel.

In France, the screening for human T-cell leukemia/ lymphoma virus type 1 and 2 (HTLV-1 and HTLV-2) during the donation of human milk has been carried out from 1992 with the application of the circular DGS 24 November 1992. The screening for antibodies against these viruses is regulated and done systematically during every donation of milk. Breast feeding being the main mode of transmission of the HTLV-1, the last ministerial decree of 25 August 2010 has made the screening test compulsory for the anonymous donation and for the personalized donation (of a mother for her own child) from all women including those affected by the infection. The milk delivered by milk banks is pasteurized (62.5 °C for 30 minutes) before freezing at -18 °C, which inactivates the pathogens. This double means of prevention of the transmission of the HTLV-1 paradoxically seems disproportionate in the absence of any precautionary measure in the case of direct breast-feeding and the use of mother's raw milk. Indeed, in most neonatal intensive care units in maternity hospitals, unpasteurized milk is administered to the neonates without any systematic preliminary testing of the serological HTLV-1 status of the mother. An increased sensitization of the community of the obstetricians, midwives and neonatologists by the Association of the Milk Banks of France (ADLF) and the Société de pathologie exotique could address the issue of screening for HTLV-1 in "donated" milk and breast-feeding.

Humeral metastasis as the only recurrence of a 5-year resected gastrointestinal stromal tumor: a case report.

INTRODUCTION: Gastrointestinal stromal tumors represent the most frequently encountered primary mesenchymal tumors. Whereas the liver and the peritoneum are known to be the preferential metastasis sites, no therapeutic standard has yet been established for the management of bone metastases because of their very low incidence. We report a unique example of a single humerus metastasis of a jejunal gastrointestinal stromal tumor. CASE PRESENTATION: We report the case of a 72-year-old European woman whose jejunal gastrointestinal stromal tumor was resected in 2013 and treated during the following 3 years with imatinib (400 mg daily). In 2018, she developed a single humeral bone lesion that was identified as a gastrointestinal stromal tumor metastasis. After 7 months of imatinib intake, reconstructive surgery was performed. Pathologists confirmed the satisfactory histological regression and assessed the complete tumor resection. The patient is still on imatinib maintenance therapy, with no recurrence reported so far. She fully recovered the upper limb function after following an appropriate rehabilitation program. DISCUSSION: Current literature and published case reports indicate that bones are one of the rarest locations of gastrointestinal stromal tumor metastasis (about 1%), with occurrence mainly in the spine. Patients initially diagnosed with gastrointestinal stromal tumor of the small intestine and stomach are more likely to suffer from bone metastasis, compared with other gastrointestinal stromal tumor locations. The median overall survival rate is higher for patients with isolated bone metastasis compared with those having liver metastasis. Metastasis occurs on average 4 years after the primary, but it may take up to 20 years, emphasizing the need for long-term clinical and radiological monitoring. Although specific guidelines for such cases have not yet been established, we suggest that a multimodal concerted approach involving surgery or radiotherapy associated with tyrosine kinase inhibitor intake should be considered. CONCLUSION: Bones are one of the rarest locations of gastrointestinal stromal tumor metastasis. A multidisciplinary collaboration was set up to allow conservative surgery of our patient after several months of imatinib treatment. A year and a half later, the patient is still in complete remission. This specific case supports the concept of an intermediate stage between local and oligometastatic disease that should be managed with a curative aim, as much as possible.

Cartilage graft from rib to treat trapeziometacarpal arthritis.

Trapeziectomy has been considered as the gold standard for treating trapeziometacarpal arthritis. But trapezial space collapse is responsible for thumb strength decrease and intracarpal deformities (with or without tendon interposition). Partial trapeziectomy with interposition of a chondrocostal autograft combines the advantages of trapeziectomy and a biological spacer without the disadvantages of arthroplasty. Partial trapeziectomy is performed by a dorsal approach, under regional anaesthesia. The graft is harvested by a direct approach of the 9th rib during a short bout of general anaesthesia and inserted in the trapeziectomy space. A thumb spica cast is used for 3-6 weeks. In our experience, long-term outcomes and radiological evolution of the graft are good, similar to that of other procedures reported in the literature, except for strength, which is better in this scenario. With more than 5 years of follow-up, the graft is viable, the length of the thumb is maintained, and any areas of graft metaplasia are localized. The result is stable over time and any donor site morbidity is anecdotal. The interposition of a biological material is feasible and produces a stable and strong thumb.

Diagnostic performance of mobile cone beam computed tomography versus conventional multi-detector computed tomography in orbital floor fractures: a study on human specimens.

The aim of this study was to evaluate the diagnostic accuracy of mobile cone beam computed tomography (MCBCT) versus multi-detector computed tomography (MDCT) in orbital floor fractures. Twenty-four fresh cadaver heads were used, and one orbital floor was fractured for each head by transconjunctival approach. MDCT and MCBCT were performed on each of the heads. The images obtained were then analysed independently by eight evaluators. The radiological characteristics of the orbital floor fractures were visualized with good interpretation agreement between the two images. The location of the fracture and enophthalmos were identified in a comparable manner with strong agreement (κ=0.93 and κ=0.85, respectively). Measurements of fatty hernias and bone defects showed a strong correlation between the two imaging modalities (Pearson coefficient between 0.64 and 0.71 and between 0.67 and 0.71, respectively). The fracture limits and the presence of bone fragments, an intrasinus fatty hernia, and a fracture of the associated medial orbital wall were visualized in both examinations with good agreement (κ=0.68, κ=0.51, κ=0.57, and κ=0.46, respectively). The soft tissue study showed superiority for MDCT, with a κ<0.0009. MCBCT showed good diagnostic performance in the study of orbital floor fracture characteristics.

Influence of the level of arterial resection on the replanting and revascularization results in hand surgery: prospective study over 22 months.

The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.

Prevalence of Rathke cleft cysts in children on magnetic resonance imaging.

PURPOSE: The purposes of this study were to estimate the prevalence of Rathke cleft cysts (RCC) in a pediatric population on brain MRI, to describe their appearance, and to estimate interobserver agreement in the detection of RCC. MATERIALS AND METHODS: The brain MRI examinations of 460 children were retrospectively reviewed by two radiologists for the presence of RCC. There were 223 boys and 237 girls with a mean age of 8.8±4.3 (standard deviation [SD]) years (range: 0.1-14.9 years). When present, RCC were analyzed with respect to internal contain and further classified as serous RCC (i.e., high signal on T2-weighted sequences and iso or low signal on T1-weighted sequences) or mucosal RCC (i.e., low signal on T2-weighted sequences and high or iso signal on T1-weighted sequences). Cohen's Kappa coefficient was used to estimate interobserver agreement between the interpretations performed by the two radiologists for the presence of RCC. RESULTS: A total of 14 children had a RCC present on brain MRI, yielding a prevalence of 3.04% (14/460); of these, 3/14 RCCs (21%) were of serous type and 11/14 (79%) were of mucosal type. Interobserver agreement for the presence of RCC was strong (Kappa=0.85; 95% CI: 0.70; 0.99). CONCLUSION: The results of our study suggest that the prevalence of RCC in children is greater than previously described.

Feasibility of two-dimensional ultrasound shear wave elastography of human fetal lungs and liver: A pilot study.

PURPOSE: The first aim was to evaluate feasibility and reproducibility of 2-dimensional ultrasound (2D) shear wave elastography (SWE) of human fetal lungs and liver between 24 and 34weeks of gestation. The second aim was to model fetal lung-to-liver elastography ratio (LLE ratio) and to assess its variations according to gestational age and maternal administration of corticosteroids. MATERIAL AND METHODS: 2D-SWE examinations were prospectively performed in fetuses of women with an uncomplicated pregnancy (group 1) and fetuses of women with a threatened preterm labor requiring administration of corticosteroids (group 2). Two 2D-SWE examinations were performed at "day 0" and "day 2" in group 1; before and 24hours after a course of corticosteroid in group 2. Three operators performed 2 cycles of 3 measurements on the lung (regions A1, A2, A3) and the liver (regions IV, V, VI). Repeatability and reproducibility of measurements were calculated. The fetal LLE ratio was modeled from the most reproducible regions. RESULTS: Fifty-five women were enrolled in group 1 and 48 in group 2. For the lung, 8.6% of measurements were considered invalid and 6.9% for the liver. The most reproducible region for the lung was A3 [ICC between 0.70 (95% CI: 0.42-0.85) and 0.78 (95% CI: 0.48-0.90)] and region VI for the liver [ICC between 0.70 (95% CI: 0.40-0.85) and 0.84 (95% CI: 0.60-0.94)]. According to gestational age, a moderate positive linear correlation was found for stiffness values of A3 (R=0.56), V (R=0.46) and VI (R=0.44). LLE ratio values at "day 0" were not different between the two groups but decreased at "day 2" in group 2 (0.2; 95% CI: 0.07-0.34; P<0.001). CONCLUSION: Quantitative fetal lung and liver stiffness measurements are possible with 2D-SWE with acceptable reproducibility.

[CT guided dual site infiltration in pudendal neuralgia]. / Infiltration scano-guidée en deux sites dans la névralgie pudendale.

PURPOSE: To assess the value of CT guided dual site infiltration in patients with pudendal neuralgia and determine prognostic factors of efficacy. Materials and methods. Retrospective review of 49 patients with suspected pudendal neuralgia who underwent one or multiple injections of local anesthetics and steroids. Patients were classified based on clinical and electrophysiological findings. RESULTS: 70% of patients with typical symptoms of pudendal neuralgia responded favorably to the infiltrations compared to 27% of patients with atypical symptoms (p<0.05). The mean number of infiltrations was 2.2. 84% of responding patients experienced symptomatic relief after the first infiltration. The mean duration of symptomatic relief was 3 months. CONCLUSION: Infiltration is an effective treatment for patients with typical pudendal neuralgia, and should be included in the management of these patients.

[Color doppler ultrasound evaluation of thoracodorsal pedicle quality after axillary lymph node dissection. A way to increase latissimus dorsi flap reliability: about 74 patients]. / Intérêt de l'évaluation échographique systématique du pédicule thoracodorsal après curage axillaire avant la levée du lambeau de latissimus dorsi. A propos de 74 cas.

The latissimus dorsi musculocutaneous flap has been widely used for breast reconstruction. It is a reliable method with low complications. Thoracodorsal pedicle is constant but might have been dissected and injured previously, for example, in case of axillary lymph node dissection. The purpose of our study is to assess the benefit of systematic preoperative echo-doppler imaging of the thoracodorsal pedicle. Seventy-four consecutive patients with unilateral axillary lymph node dissection undergoing latissimus dorsi flap underwent doppler and color duplex sonography of the thoracodorsal pedicle preoperatively. Non operated and contralateral pedicle served as reference. A total of 12.2% patients had differences between operated and non operated pedicle, 9.5% had smaller operated pedicle and 2.7% patients had stenosis with altered blood flow. Stenosis of the pedicle contraindicates, in our unit, latissimus dorsi flap because of altered blood flow. There were no flap necrosis in our series. The percentage of stenosed pedicle in our series is similar to percentage of flap necrosis in the literature. We think that systematic doppler and color duplex sonography of the thoracodorsal pedicle increase the reliability of latissimus dorsi flap by excluding pedicle with altered blood flow.

Posterior interosseous nerve of the elbow at the arcade of Frohse: Ultrasound appearance in asymptomatic subjects.

PURPOSE: To assess the normal values of the antero-posterior (AP) diameter of the posterior interosseous nerve (PIN) of the elbow as it passes beneath the arcade of Frohse and to search for PIN-diameter differences between the upstream, entry point and downstream of the arcade. MATERIAL AND METHODS: Thirty asymptomatic patients prospectively underwent bilateral B-mode ultrasound of the PIN of the elbow. There were 15 men and 15 women with a mean age of 30.2±5.31 (SD) years (range: 26-43 years). Of these, 23 patients were right-handers (23/30; 77%) and 7 were left handers (7/30; 23%). AP diameter of the PIN was measured in long axis at three different locations including the entry point of the arcade, 5-mm upstream and 5-mm downstream the arcade. A comparison between the three measurements was performed using paired t-test. RESULTS: The mean AP diameters of the PIN were 0.83±0.21 (SD) mm (range: 0.43-1.31mm), 0.6±0.17 (SD) mm (range: 0.29-1.16mm) and 0.49±0.13 (SD) mm (range: 0.26-0.86mm) at 5-mm upstream, entry point of the arcade and 5-mm downstream the arcade of Frohse, respectively. Significant drops in PIN diameter were found between upstream and the arcade (-0.23mm; 27%; P<0.001), between the arcade and downstream (-0.11mm; 17%; P<0.001), and between upstream and downstream the arcade (-0.34mm; 40%; P<0.001). CONCLUSION: Disparity in AP diameter of the PIN of the elbow in the arcade of Frohse is a normal finding and should not be erroneously interpreted as entrapment when present alone.

Improved contrast for myeloma focal lesions with T2-weighted Dixon images compared to T1-weighted images.

PURPOSE: The purpose of this study was twofold. First, to compare the contrast between spinal multiple myeloma (MM) focal lesions and surrounding bone marrow obtained on T2-weighted Dixon fat-only MR images to that obtained on T1-weighted spin-echo images. Second, to search for correlation between bone marrow fat fraction assessed by T2-weighted Dixon sequence and International Myeloma Working Group myeloma defining events. MATERIALS AND METHODS: A total of 39 patients with 112 focal MM lesions were included. There were 25 men and 14 women with a mean age of 68.8±9.8 [SD] years (range: 49-88 years). Contrast between focal MM lesions and surrounding bone marrow was calculated on T1-weighted spin-echo and T2-weighted Dixon (including water-only and fat-only) images. Contrast between focal MM lesions and bone marrow was compared using ANOVA and post-hoc Tukey tests. Correlation between bone marrow fat fraction and myeloma defining events was assessed using Spearman's correlation test. RESULTS: MM lesion contrast was greater on T2-weighted Dixon (F (2;93)=35.10) than on T1-weighted images (P<0.0001). Greatest MM lesion contrast was achieved with T2-weighted Dixon fat-only (0.63±0.21 [SD]; range: 0.06-0.91) compared to T2-weighted Dixon water-only (0.45±0.20 [SD]; range: 0.07-0.8) (P=0.0003) and T1-weighted (0.23±0.19 [SD]; range: 0.04-0.87) (P<0.0001) images. There were no significant correlations between myeloma defining events and fat fraction. CONCLUSION: T2-weighted Dixon fat-only images provide greater contrast between MM lesions and adjacent bone marrow than T1-weighted images. The usefulness of a T1-weighted sequence associated to a T2-weighted Dixon sequence has to be determined.

Can three-dimensional pelvimetry using low-dose stereoradiography replace low-dose CT pelvimetry?

PURPOSE: To evaluate the reliability of pelvimetric measurements performed using stereoradiographic imaging (SRI), and to assess maternal and fetal radiation doses compared to low-dose computer tomography (CT) pelvimetry. MATERIALS AND METHODS: Thirty-five pregnant women (mean age, 29.6±5.5 [SD] years; range: 20-41 years) were prospectively included. All women underwent simultaneous frontal and lateral low-dose SRI and low-dose CT examination of the pelvis. Pelvimetry measurements were obtained from both examinations and radiation doses obtained with the two techniques were compared. RESULTS: SRI-CT correlation (Pearson coefficient correlation [r]; mean bias [mb]) was strong for transverse inlet diameter (r=0.92; mb=-0.09cm), anteroposterior diameter of the pelvic inlet (r=0.92; mb = 0.47cm), maximal transverse diameter (r=0.9; mb=0.21cm), sacrum length (r=0.9; mb=0.09cm). Correlation was good. Correlation was good for the sacrum depth (r=0.75; mb=0.06cm) and Magnin's index (r=0.7; mb=0.5cm). Correlation was moderate for anteroposterior diameter of pelvic outlet (r=0.6; mb=0.52cm). The fetal dose was 13.1 times lower using SRI (87±26µGy) than CT (1140±220µGy, P<0.0001). The effective maternal dose was 3.1 times lower using SRI (97±21µSv) than CT (310±60µSv; P<0.0001). CONCLUSION: Pelvic inlet measurements using SRI are reliable. Compared to CT pelvimetry, SRI leads to a significant decrease in fetal and maternal radiation doses. These findings should prompt physicians to use SRI as the first-line approach for pelvimetry.

Usefulness of ultrasound for the diagnosis of pyogenic flexor tenosynovitis: A prospective single-center study of 57 cases.

Pyogenic flexor tenosynovitis (PFT) is a functional emergency in hand surgery; however, its diagnosis can be difficult to make. It should always be considered when a patient presents with an inflamed finger. The goal of this study was to investigate the usefulness of ultrasound in the diagnosis of early PFT. Seventy-three patients with suspected pyogenic flexor tenosynovitis were candidates for the study. Since the diagnosis of PFT was obvious in 16 patients, they were excluded from the study and immediately underwent surgery. The remaining 57 patients underwent a clinical examination by a senior surgeon, a blood test for C-reactive protein levels and an ultrasound (US). The US results were compared to the intraoperative findings if the patients were operated or to the clinical outcome in non-operated patients. Seventeen patients had the US diagnosis of PFT confirmed intraoperatively. In 10 patients, the US diagnosis of PFT was not confirmed intraoperatively. In 29 other patients, the diagnosis of PFT was ruled out by US; they all had good outcomes after being treated with antibiotics. In one patient for whom the diagnosis of PFT had been ruled out by US, PFT was actually present. Ultrasound had 94% sensitivity, 65% specificity, 63% positive predictive value, and 95% negative predictive value. Ultrasound is useful as a diagnostic tool for managing early PFT thanks to its excellent negative predictive value and specificity. This objective examination complements the surgeon's subjective clinical examination.

Embryonic death of Mek1-deficient mice reveals a role for this kinase in angiogenesis in the labyrinthine region of the placenta.

Mek is a dual-specificity kinase that activates the extracellular-signal-regulated (Erk) mitogen-activated protein (MAP) kinases upon agonist binding to receptors. The Erk MAP kinase cascade is involved in cell-fate determination in many organisms. In mammals, this pathway is proposed to regulate cell growth and differentiation. Genetic studies have shown that although a single mek gene is present in Caenorhabditis elegans, Drosophila and Xenopus, two mek homologs, Mek1 and Mek2, are present in the mammalian cascade. In the present study, we describe a mutant mouse line in which the mek1 gene has been disrupted by insertional mutagenesis. The null mutation was recessive lethal, as the homozygous mutant embryos died at 10.5 days of gestation. Histopathological analyses revealed a reduction in vascularization of the placenta that was due to a marked decrease of vascular endothelial cells in the labyrinthine region. The failure to establish a functional placenta probably explains the death of the mek1-/- embryos. Cell-migration assays indicated that mek1-/- fibroblasts could not be induced to migrate by fibronectin, although the levels of Mek2 protein and Erk activation were normal. Re-expression of Mek1 in the mutant mouse embryonic fibroblasts (MEFs) restored their ability to migrate. Our findings provide genetic evidence that establishes the unique role played by Mek1 in signal transduction. They also suggest that mek1 function is required for normal response to angiogenic signals that might promote vascularization of the labyrinthine region of the placenta.

[Combined bipolar radiofrequency and cementoplasty of bone metastases]. / Radiofréquence bipolaire et cimentoplastie dans le traitement des métastases osseuses.

Bone metastases are the most common cause of pain in cancer patients. Pain management in cancer patients, often revealing the disease and always present at advanced stages, is an important and difficult task. Pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous neurolysis, infiltrations, alcoholizations and cementoplasty may be considered. More recently RF ablation has been proposed. On weight-bearing bones, RF can be combined with acrylic cement injection. The authors present here this very effective new technique which is complementary to classical pain management techniques.

Extensor indicis proprius tendon transfer using shear wave elastography.

The means for judging optimal tension during tendon transfers are approximate and not very quantifiable. The purpose of this study was to demonstrate the feasibility of quantitatively assessing muscular mechanical properties intraoperatively using ultrasound elastography (shear wave elastography [SWE]) during extensor indicis proprius (EIP) transfer. We report two cases of EIP transfer for post-traumatic rupture of the extensor pollicis longus muscle. Ultrasound acquisitions measured the elasticity modulus of the EIP muscle at different stages: rest, active extension, active extension against resistance, EIP section, distal passive traction of the tendon, after tendon transfer at rest and then during active extension. A preliminary analysis was conducted of the distribution of values for this modulus at the various transfer steps. Different shear wave velocity and elasticity modulus values were observed at the various transfer steps. The tension applied during the transfer seemed close to the resting tension if a traditional protocol were followed. The elasticity modulus varied by a factor of 37 between the active extension against resistance step (565.1 kPa) and after the tendon section (15.3 kPa). The elasticity modulus values were distributed in the same way for each patient. The therapeutic benefit of SWE elastography was studied for the first time in tendon transfers. Quantitative data on the elasticity modulus during this test may make it an effective means of improving intraoperative adjustments.