Long head of biceps femoris flap in anal fistula treatment: anatomical study and case report.

In case of complex anal fistulae, the treatment can include muscular flaps. The gracilis transposition flap is the gold-standard in perineal reconstructive surgery, with wide use during the past decades. However, in some cases, this flap is too short to reach difficult locations such as the posterior perineum. The long head of the biceps femoris, which has already been studied in the electrically stimulated neosphincter formation, could be more appropriate in such clinical situations. Furthermore, its potential advantages, amongst which an excellent functional outcome, would be to allow persistent prone position, during both treatment and reconstruction, as well as a more favorable intramuscular vascularisation. We report the case of a 39-year-old man with a complex recurrent transphincteric posterior anal fistula with an external orifice in the right buttock and complicated with a severe cellulitis, treated with an endo-anal flap combined with a long head of biceps femoris pediculised flap.

Requirements analysis and preliminary design of a robotic assistant for reconstructive microsurgery.

Microanastomosis is a microsurgical gesture that involves suturing two very small blood vessels together. This gesture is used in many operations such as avulsed member auto-grafting, pediatric surgery, reconstructive surgery - including breast reconstruction by free flap. When vessels have diameters smaller than one millimeter, hand tremors make movements difficult to control. This paper introduces our preliminary steps towards robotic assistance for helping surgeons to perform microanastomosis in optimal conditions, in order to increase gesture quality and reliability even on smaller diameters. A general needs assessment and an experimental motion analysis were performed to define the requirements of the robot. Geometric parameters of the kinematic structure were then optimized to fulfill specific objectives. A prototype of the robot is currently being designed and built in order to providing a sufficient increase in accuracy without prolonging the duration of the procedure.

Lesions of the ovary with T1-hypersignal.

Pelvic magnetic resonance imaging (MRI) has been used successfully to diagnose ovarian masses that cannot be adequately evaluated using pelvic ultrasound. T1 hyperintensity is a common finding in an ovarian mass and has important diagnostic implications. The aims of this review are to list the substances that may produce high signal intensity on T1-weighted MRI, to explain the physical basis for causes of the high T1 signal intensity, and to describe common and uncommon T1 hyperintense ovarian lesions. The morphological findings, the imaging features of the additional sequences, and clinical variables can help in the differential diagnosis, and in some cases, enable a specific diagnosis, leading to appropriate management of the patient.

PET-CT and diagnostic CT: the synergy of metabolic and morphological data in onco-haematology.

PURPOSE: Our goal was to determine how interpreting diagnostic CT together with PET-CT could improve the assessment of morphology in onco-haematology. PATIENTS AND METHODS: Fifty-nine patients with aggressive lymphoma were retrospectively included. The diagnostic CT scan was interpreted by two radiologists, followed by a combined analysis of the CT and the PET-CT carried out by two specialists in metabolic and morphological imaging. The diagnostic performances were assessed in terms of sensitivity and specificity, then concordance and discordance rates (kappa) were studied. RESULTS: A combined interpretation of CT and PET-CT showed better diagnostic performances than those of interpretations of CT only in the assessment of nodal sites (826 sites, sensitivity of 99% versus 85%, P<0.05), extranodal sites (649 sites, sensitivity of 88% versus 78%) and bone sites (one analysed per patient, sensitivity of 50% versus 27%). The combined interpretation also improved inter-observer agreement and led to an upgraded Ann Arbor staging in 15% of patients, with a change of treatment in 10%. CONCLUSION: Interpretation of diagnostic CT in onco-haematology can be improved by combining it with an assessment of PET-CT. The synergy between metabolic and morphological information leads to improved diagnostic capabilities and renders interpretations more reproducible.

Pathologies of the male breast.

The majority of breast lesions in men are benign. Gynaecomastia is a very common condition in which hormonal changes cause male breasts to enlarge. Three radiological patterns of gynaecomastia have been described: nodular, dendritic, and diffuse glandular pattern. The main differential diagnosis is lipomastia, which is when adipose tissue deposits are found in the subcutaneous tissue. Male breast cancer is rare. The main risk factors are pathologies that cause hormonal imbalances, a history of chest irradiation, and a family history of breast cancer (particularly in families carrying a mutation of the gene BRCA2). Mammography usually shows a mass with no calcifications. Sonography is useful to investigate local disease spread, and for detecting any enlarged axillary lymph nodes. MRI is not currently indicated to investigate male breast cancer. Very often, the clinical examination alone is enough to distinguish benign lesions from malignant lesions. Imaging must not be automatically carried out, but rather it should be used when the diagnosis is clinically uncertain or when patients present risk factors for breast cancer, as well as for guiding biopsies and for assessing disease spread.

[Use of Extensor digitorum brevis flap in routine reconstructive surgery of lower limbs. Report of more than 50 cases]. / Utilisation du lambeau Extensor digitorum brevis en pratique courante de la chirurgie reconstructrice des membres inférieurs. Une expérience de plus de 50 cas.

The authors report their experience about more than 50 patients with soft tissue defects in the area of the lower leg, of the ankle and of the dorsal aspect of the foot and toes, managed with the Extensor digitorum brevis flap. We have most often performed it with a proximal pedicle. Healing was obtained for all case. Infections of malleola have been treated thank to the better delivery of antibiotics. The donor site shows often delayed healing, but in one case, the harvestment area has presented a complete necrosis, which healed with immobilisation of the ankle with external fixator and dressings. At last, we insist on the fast learning of the procedure and the aim to use it in humanitary mission.

[Soft tissue myoepithelioma of the ring finger of the right hand with intraosseous extension: a case report]. / Tumeur myoépithéliale des tissus mous avec extension intraosseuse dans la première phalange de l'annulaire : à propos d'un cas clinique.

Myoepithelial soft tissue tumors represent less than 1% of soft tissue tumors. Diagnosis is based on histology, but clinical and radiological features can orient the practitioner. Myoepithelial tumors do not involve the bone as they are not malignant. In this article, we report a case of a myoepithelioma occuring on the volar aspect of the right ring finger involving the first phalanx.

Techniques for coverage of infected vascular grafts in the groin.

Plastic surgeons expertise is requested for treatment of vascular graft exposures. Exposure within the femoral triangle (Scarpa) represents the majority of those cases. We intend to share our experience in the coverage of exposed vascular grafts: through the most common and safe procedures we are currently using, illustrated by some of our clinical cases. Our experience leaded us to formulate some guidelines and conclusions, to ensure vascular surgeons that coverage of a vascular graft can always be successfully done.

Endoscopic decompression and drainage of benign and malignant biliary obstruction.

Successful performance of endoscopic sphincterotomy in the treatment of choledocholithiasis led to the placement of retrograde, transpapillary catheters for internal drainage and prevention of cholangitis. This technique presented the opportunity for using nasobiliary tubes for short term treatment of this problem or placing a permanent drain into the bile duct for long term management. Internal drains placed endoscopically have been used on 15 occasions: 10 nasobiliary and five permanent. These drains have functioned well without complications prompting us to recommend this approach in patients with benign or malignant obstruction of the biliary tree.

Endoscopic incision of choledochal cysts (choledochocele).

Congenital cysts of the ble ducts and liver usually present with symptoms of compression, obstruction or infection. The management of these problems has been the surgical approach with extirpation or diversion techniques. Cysts of the common hepatic or bile ducts should be completely excised if possible while intrahepatic cysts are treated by anastomosis of the ducts to isolated intestinal loops. Diversion techniques for distal intraduodenal cysts leads to development of the sump syndrome, and, it has been our experience in two patients to treat these, choledochocele, by incision during performance of a sphincterotomy.

Hepatitis B serologic studies in narcotic users with chronic liver disease.

Hepatitis B surface antigen (HBsAG) and antibody (anti-HBs), and antibody to the hepatitis B core antigen ( anti-HBc) were measured by radioimmunoassay in 46 current or former narcotic users who underwent liver biopsy for evaluation of chronic liver disease. Significant alcohol abuse was found in 38 narcotic users (82.6%). On liver biopsy, 24 had cirrhosis (52.2%), nine had chronic active hepatitis (19.6%), five had lipid accumulation (10.9%) and eight had other diagnoses (17.4%). At least one marker for hepatitis B was found in 45 of 46 narcotic users (97.8%). Five had HBsAg and anti HBc (10.9%), one had anti-HBs alone (2.2%), 30 had anti-HBs and anti-HBc (65.2%) and nine had anti-HBc alone. Although almost all narcotic users with chronic liver disease have active or resolved hepatitis B infection, alcohol abuse appears to be the major factor in the development of cirrhosis in the subset of narcotic users studied.