[Influence of age, growth potential and functionality in the management of bone tumours in children : example of the rotationplasty]. / Cas clinique. Influence de l'âge, du potentiel de croissance et de la fonctionnalité dans la prise en charge des tumeurs osseuses de l'enfant : exemple de la plastie de rotation.

Malignant bone tumours in children are rare diseases whose survival rate has progressively improved in recent years thanks to advances in pharmacology, surgery and radiotherapy. We present the particular case of a very young child with Ewing's sarcoma of the thigh. We discuss the influence of this young age on short and long term care. Limb skeletal immaturity and the residual growth potential need to be integrated to define the safest oncological and functional strategy. For this purpose, we summarize the different possible reconstructive options. We describe the Van Nes rotationplasty that was proposed in our patient's case and we will detail the issues in terms of functional well-being and self-image.

Les tumeurs malignes osseuses de l'enfant sont des pathologies rares dont la survie s'est progressivement améliorée au cours des dernières années grâce aux progrès médicamenteux, chirurgicaux et radiothérapeutiques. Nous présentons le cas particulier d'une très jeune enfant atteinte d'un sarcome d'Ewing de la cuisse. Nous discutons de l'influence de ce jeune âge sur la prise en charge à court et à long termes. L'immaturité squelettique et le potentiel de croissance résiduelle des membres doivent être intégrés pour définir l'attitude la plus sûre sur le plan oncologique et la plus fonctionnelle. à cette fin, nous résumons les différentes options reconstructives possibles. Nous décrivons la plastie de rotation de Van Nes qui a été proposée à notre patiente et nous détaillerons les enjeux relatifs au bien-être fonctionnel et à l'image de soi.

Management of neglected post-traumatic ipsilateral distal femoral and proximal tibial epiphysiodeses in adolescent: Case report.

Introduction: It is important to remember the risk of post-traumatic epiphysiodesis in the context of high-speed impacts around the knee. This clinical case illustrates the risk of lower limb length discrepancy resulting from this, the treatment and management thereof. This case is unique in that it presents two ipsilateral distal femoral and proximal tibial epiphysiodeses, with secondary inequality of these two bone segments. Case presentation: A 13-year-old adolescent is managed for a displaced diaphyseal fracture of the distal femur. He undergoes surgery for this fracture. He suffered high velocity trauma and is also likely to have suffered Salter V trauma to his distal femoral and proximal tibial ipsilateral physes. The consequence is an unequal length of the tibias and femurs. A femoral lengthening is performed and allows to restore a symmetry of the femurs. The asymmetry of the tibias is neglected, and a residual asymmetry persists and will be corrected later. Discussion: The important elements on the management of high-speed trauma around the knee are recalled. A good assessment of bone growth is necessary and individualized treatment should be chosen. This case is particularly interesting because of the nature of the injuries, their consequences and their treatment. Unfortunately, neglecting the suspicion of physes injuries (especially in proximal tibial) is to be noted.

Sciatic nerve entrapment by pentazocine-induced muscle fibrosis: a case report.

A progressive bilateral sciatic neuropathy appeared in a 52-year-old man as an unusual complication of pentazocine-induced muscle fibrosis. Surgical neurolysis showed that the sciatic nerves were firmly compressed by large fibrous bands involving the entire gluteal musculature.

Quantitative analysis of a synthetic adjuvant by an immunoassay.

Antibodies against a sulpholipo-derivative of synthetic polysucrose (SL-Ficoll) were prepared with the purpose of developing a detection system for this adjuvant component. SL-Ficolls with polysucrose backbones of 400 kDa (SL-Ficoll400) or 22 kDa (SL-Ficoll22) were not immunogenic. However, SL-Ficoll22 conjugated to bovine serum albumin (SL-Ficoll22-BSA) induced high levels of specific antibodies against SL-Ficoll in mice as determined by an indirect ELISA with either SL-Ficoll400 or SL-Ficoll22 as coating antigen. The specificity of the antibodies was analysed further in a blocking ELISA with SL-Ficoll400 as coat. Dose-dependent inhibition of the ELISA titre was obtained with SL-Ficoll22 and SL-Ficoll400 and the concentration causing 50% inhibition (IC50) was < 1 microg/ml. Non-derivatised polysucrose (Ficoll400) and compounds lacking either lipid or sulphate were not recognised (IC50 > 1000 microg/ml). The reaction of SL-Ficoll400-derivatives with antibodies increased with increasing sulphate and lipid content and maximal inhibition was produced by compounds with a composition similar to the SL-Ficoll22 used for immunisation. Quantitative analysis of SL-Ficoll400 in adjuvant formulations comprising SL-Ficoll400 incorporated in a squalane-in-water emulsion revealed high recovery and sufficient precision. From these data, we conclude that specific antibodies are generated against the synthetic SL-Ficoll400 and that this component of a novel adjuvant formulation can be quantified by an immunoassay.

Analysis of oral uptake of a synthetic adjuvant by an immunoassay with monoclonal antibodies.

A blocking ELISA with specific antibodies against a synthetic sulpholipo-polysucrose (SL-Ficoll400) was developed to quantify this vaccine adjuvant component in faeces with the purpose of estimating the uptake thereof by the gastrointestinal tract after oral administration. Specific monoclonal antibodies (MABs) prepared against SL-Ficoll400 did not cross-react with components in murine faeces. SL-Ficoll400 inhibited the reactivity of the MABs in a dose-dependent fashion in the blocking ELISA and the concentration causing 50% inhibition (IC50) was about 1 microg SL-Ficoll400 per milliliter. Derivatives of Ficoll400 lacking sulphate or lipid groups or both were unable to block the MABs (IC50 > 1000 microg/ml) which confirmed the specificity of the test system. Quantification of SL-Ficoll400 in extracts of faeces of untreated mice spiked with SL-Ficoll400 revealed that more than 90% could be recovered. The blocking ELISA was used to quantify SL-Ficoll400 in the faeces of mice given this compound orally. One, two and three days after oral administration, the cumulative recovery of SL-Ficoll400 in faeces was 30, 40 and 92%, respectively. From these data, we concluded that the MABs obtained were specific for SL-Ficoll400, that SL-Ficoll400 in murine faeces could be quantified by a blocking ELISA with MABs and that SL-Ficoll400 was poorly absorbed by the gastrointestinal tract.

Plasmacytoma of the thyroid: a case report, a study with use of the immunoperoxidase technique, and a review of the literature.

A case of solitary plasmacytoma of the thyroid is reported. A monoclonal component (IgG lambda) was identified in the serum of the patient and disappeared after total thyroidectomy and radiotherapy. The use of the immunoperoxidase technique on thyroid, bone marrow, and lymph node specimens allowed us to demonstrate the production of IgG lambda by the tumor, and to rule out the possibility of multiple myeloma. Previously reported cases are reviewed (15 cases). The diagnostic criteria, the association with thyroiditis, and the treatment of this rare disorder are discussed.

Non-toxic antiseptic irrigation with chlorhexidine in experimental revascularization in the rat.

The effect of different wound irrigation fluids upon femoral arteries and veins was investigated in the rat, using microsurgical techniques. Toxicity was evaluated by microscopical observation after selective staining of histological slides. Povidone-iodine, 10%, proved to be a very irritant solution, provoking an attack on the vascular endothelium and secondary thrombosis. Chlorhexidine at 0.05%, 0.02% and 0.001% was found by contrast to have a very low toxicity which was comparable to physiological saline. Experimental investigation of antiseptic solutions should not only include the determination of the antibacterial effect, but also the potential for cell toxicity, using an irrigation technique.

Effect of various adjuvants on secondary immune response in chickens.

Stimulatory effects of several types of adjuvants on secondary antibody response to inactivated Newcastle disease virus (iNDV) were examined in chickens. For this purpose, animals were primed with iNDV without adjuvant resulting in a low but significant antibody response, boosted with iNDV plus adjuvant 3 weeks later, and analysed for specific antibody titres in serum 3 weeks after the booster. Water-in-mineral oil emulsion (W/O) caused significant increase in antibody titres measured in an indirect enzyme-linked immunosorbent (ELISA), haemagglutination inhibition (HI), and virus neutralisation (VN) assay. The adjuvants tested included three oil-in-water emulsions (i.e. mineral oil-in-water, sulpholipo(SL)-Ficoll400/squalane-in-water and sulpholipo-cyclodextrin/squalane-in-water), three negatively-charged polymers with high molecular weight (i.e. polyacrylate, polystyrenesulphonate and sulpho(S)-Ficoll400) and two surface-active agents (i.e. dimethyldioctadecylammonium bromide (DDA) and Quil A). These adjuvants enhanced significantly the secondary immune response but none reached the titre obtained with W/O. Combinations of adjuvants with distinct physicochemical properties, i.e. polyacrylate and DDA revealed only slight, beneficial effects. We concluded that the various types of adjuvants tested can stimulate secondary immune responses in primed animals but that W/O is superior.

[Injuries and seat belts]. / Traumatisme et ceinture de sécurité.

The effectiveness of the seat belt in reduction of road fatalities and injuries is well known. Nevertheless, improper or incorrectly wearing of the seat belt can induce specific cervical, thoracic or abdominal lesions. With reference to the literature and clinical reports, the authors describe the specific lesions of the seat belt syndrome. Superficial lesions are frequently associated with underlying deep lesions.

[Thoughts about 20 cases of hyperparathyroidism (author's transl)]. / Réflexions à propos de 20 cas d'hyperparathyroïdie.

The analysis of 20 personal cases of parathyroid hyperplasia or adenoma suggest the following conclusions: 1. The importance of dosage of the parathormone is a decisive factor of the diagnosis and yields data: a) in relation with the volume of the adenoma; b) that return to normal 24 hours after resection; c) that constitute the proof of complete resection. 2. The little utility of the diagnosis of location bij means of elaborate paraclinical exams. The authors show false positive angiograms. Only the inspection of the four parathyroids and of the main heterotopic areas is a valid means of disclosing the lesions responsible of the hyperparathyroidism. It is essential to operate with a skilled pathologist who will read frozen sections.

[Current emergency treatment of lesions of the flexor tendons: anatomical, biomechanical and cicatricial aspects]. / Traitement actuel des lésions des tendons fléchisseurs en urgence: les notions anatomiques, biomécaniques et cicatricielles.

Emergency treatment of flexor tendon lesion in 1988: anatomic biomechanical and healing characteristics. Flexor tendon surgery in 1988 must take into account detailed anatomic knowledge as well as healing and biomechanical properties of flexor tendons. Application of standardised surgical technics allows reliable treatment when the surgeon is familiar with these technics and the basic knowledge they suppose. The authors detail the technics and certain details with practical goals.

[Current treatment of fresh lesions of the flexor tendons]. / Traitement actuel des lésions fraîches des tendons fléchisseurs.

Different aspects of primary treatment of flexor tendon lesions are reviewed. Of outstanding importance are: adequate setting and instruments plus meticulous repair with fine material, avoidance of traumatic manipulation of structures and anatomical repair, use of dynamic mobilisation of reconstructed tendons within a team of well informed and motivated therapists.

[Current trends in experimental peripheral nerve regeneration]. / Nouvelles orientations en régénération nerveuse périphérique expérimentale.

Large posttraumatic defects in the peripheral nervous system need to discover methods to solve the demand of nerve grafts. There is no definite answer now. The authors present a model for nervous regeneration studies. Experiments are performed in the Wistar rat. A venous isograft is used to bridge defects of various size in a divided rat sciatic nerve. The venous tube is a guide for axonal regeneration. In one series, the tube is filled with physiological saline and, in a second one, neonatal Schwann cells are injected in the venous isograft. Results recorded are a combination of quantitative methods: neurophysiology and morphometry. The injection of neonatal Schwann cells is able to stimulate nerve regeneration but not completely.