Deferral from donating blood of men who have sex with men: impact on the risk of HIV transmission by transfusion in France.

BACKGROUND: In France, men who have sex with men (MSM) are permanently excluded from blood donation. This policy is felt to be discriminatory by MSM activists. Furthermore, the policy is not fully respected because some MSM do not report their sexual behaviour before donating. METHODS: We estimated the fraction of the current risk of HIV attributed to MSM. We then constructed a model based on data obtained from behavioural and epidemiological surveys to assess the impact of a new strategy in which MSM would only be deferred if they report more than one sexual partner in the last 12 months. RESULTS: Thirty-one HIV seroconversions occurred among repeat donors between 2006 and 2008, giving a risk of one in 2 440 000 donations. Fifteen of these seroconversions (48%) were MSM. If all MSM had abstained from donating blood, the risk would have been 1 in 4 700 000 donations, half the current risk. The new strategy would result in an overall HIV risk of between 1 in 3 000 000 (close to the current risk) to 1 in 650 000 donations (3·7 times higher than the current risk). CONCLUSIONS: Changing the current MSM deferral policy may increase the risk of transfusion-transmission of HIV. However, this does not take into account a possible better compliance with MSM with a less stringent policy that would be perceived as more equitable. Conversely, relaxing the policy could encourage some MSM to seek an HIV test in blood centres. Thus, further qualitative study is needed to assess possible changes in compliance linked to a new policy.

Recently acquired HIV infection in men who have sex with men (MSM) in France, 2003-2008.

An increase in the number of new HIV diagnoses among men who have sex with men (MSM) has been observed in several countries in the early 2000s. In this article, we explore the trends in MSM in France between 2003 and 2008. To estimate the number of MSM newly diagnosed with HIV, we take into account the reporting delay, underreporting and missing data for HIV case notification. To identify recent infections (RI) (acquired an average of six months before diagnosis), we used an enzyme immunoassay for recent HIV-1 infections (EIA-RI) which has been performed routinely for new HIV diagnoses since 2003. Multivariate analysis was used to identify factors associated with RI. We estimate that between 1,900 and 2,400 MSM have been newly diagnosed with HIV every year: the proportion of MSM among all newly diagnosed with HIV cases has increased from 25.2% (95% confidence interval (CI): 23.3-27.1) in 2003 to 37.0% (95% CI: 35.2-38.7) in 2008 and was stable during the period 2006-2008. In 2008, the rate of newly diagnosed HIV cases per 10,000 MSM living in France was 72.5. The proportion of non-B subtypes of HIV-1 among cases diagnosed in MSM was 11.7% (2003-2008). The assessment of RI was performed for 4,819 MSM newly diagnosed with HIV in 2003-2008. Of these, 47.6% (95%CI = 46.2-49.0) (2,295 cases) were shown to have been recently infected. The risk of RI was greater for those of French nationality (adjusted odds ratio (aOR) =1.6 [95% CI: 1.4-1.9]), those with high economic status (aOR =1.4 [95% CI: 1.2-1.8]), those tested after a risk exposure (aOR =1.6[95% CI: 1.3-1.8]) or after presenting with clinical symptoms or abnormal biological markers (aOR =1.8 [95% CI: 1.5-2.0]), those who had tested for HIV three or more times during their life-time (aOR =4.2 [95% CI: 3.4-5.2]) and those living in the Paris area (aOR =1.2 [95% CI: 1.0-1.3]). The risk of RI decreased with age. The HIV situation among MSM living in France is a cause of concern, despite the prevention campaigns dedicated to this highly educated sub-population.

An arthroscopic technique to treat the iliotibial band syndrome.

Iliotibial band syndrome (ITBS) is an overuse injury mainly affecting runners. The initial treatment is conservative. Only, in recalcitrant cases surgery is indicated. Several open techniques have been described. The purpose of this study is to evaluate the results of a standardized arthroscopic technique for treatment of a resistant ITBS. Thirty-six athletes with a resistant ITBS were treated with a standardized arthroscopic technique, limited to the resection of lateral synovial recess. Thirty-three patients were available for follow-up (mean 2 years 4 months). Thirty-two patients (34 knees) had good or excellent results. All patients went back to sports after 3 months. In two patients a meniscal lesion was found, which required treatment. One patient with only a fair result had associated cartilage lesions of the femoral condyle. Our results show that arthroscopic treatment of resistant ITBS is a valid option with a consistently good outcome. In addition, this arthroscopic approach allows excluding or treating other intra-articular pathology.

["Isolated" injury of the posterior cruciate ligament. Surgical treatment of isolated posterior cruciate ligament tears: a multicentric retrospective study of 103 patients]. / Traitement chirurgical d'une rupture isolée du ligament croisé postérieur: résultats d'une série rétrospective multicentrique de 103 patients.

PURPOSE OF THE STUDY: We present a retrospective multicentric series of carefully selected patients presenting "isolated" laxity of the posterior cruciate ligament. MATERIAL AND METHODS: The series included 103 patients who were reviewed clinically (with a dedicated review chart) and radiographically with measurement of posterior laxity (Telos 15 kg). RESULTS: In these patients with an isolated injury of the PCL (without associated injury of the peripheral ligament) DISCUSSION: The short follow-up of this series (four years) does not enable an assessment of the risk or benefit of PCL ligamentoplasty for arthrosic knees.

[Management of myocardial infarction in patients over 75 years of age from 1983 to 1999]. / Prise en charge de l'infarctus du myocarde du suiet de plus de 75 ans de 1983 a 1999.

Elderly patients are often excluded from therapeutic methods which have been shown to improve the prognosis of myocardial infarction (MI). The aim of this study was to describe the changes in management of MI in the elderly and to analyse the factors associated with hospital mortality due to MI during this period. All cases of acute MI in patients over 75 years of age from 1983 to 1999 and admitted to the Centre Hospitalier du Val d'Ariège were reviewed. The clinical features, the modalities of initial management and their treatment on discharge were compared by periods: 1983-88, 1989-93 and 1994-99. The changes in hospital mortality and the factors associated with this mortality were studied. Five hundred and forty-four cases of patients with an average age of 81 years were reviewed. The proportion of patients who were treated medically alone decreased over the 3 periods whereas treatment by angioplasty and thrombolysis increased (1.2% in 1983-88 versus 18.2% in 1994-99). Betablockers, ACE inhibitors and aspirin were much more prescribed on discharge from hospital. In parallel, the hospital mortality from MI decreased by half (50.8% in 1983-88 versus 24.9% in 1994-99). The independent factors associated with hospital mortality were age, anterior infarction (OR = 2.08 [1.39-3.13]), revascularisation of the culprit artery by thrombolysis or angioplasty (OR = 0.24 [0.09-0.61]) and the period of hospital stay (OR = 0.22 [0.12-0.38] in 1994-99 compared with 1983-88). The authors' experience reflects an improved prognosis of MI in the elderly partially due to the benefits of treatment by angioplasty and thrombolysis. Improvement of pre-hospital treatment, better diagnostic methods and more aggressive management of the elderly with MI also contribute to these results.

[Treatment of chronic ankle instability with the Chrisman-Snook's technique]. / Traitement des instabilités chroniques de la cheville par la technique de Chrisman-Snook.

PURPOSE OF THE STUDY: We report our experience on lateral ankle instability treated by the Chrisman Snook procedure. We studied the objective and subjective results as well as the effect on peroneus brevis tendon function. MATERIAL AND METHODS: Among 110 patients treated for chronic lateral ankle instability between 1991 and 1997, 32 cases were treated with this technique. The average age was 25 years (16-37) and the average time to surgery from the initial trauma was 30 months. This was a retrospective study using the Karlson Peterson form while the laxity was measured with Telos device (120 N). Cybex testing was performed on 10 patients. Twenty-seven patients participated in sport. RESULTS: The follow-up ranged from 6 to 65 months (average 25 months). The average Karlson's score was 82.6 with 78 per cent excellent and good results. Lateral ligament laxity was reduced from 17 mm to 4 mm on Telos measurements and no osteoarthritis was noticed radiographically. The joint mobility consistently returned to the preoperative level. Twenty four patients returned to sport although half of the patients had some pain during sport activities or with fast walking. DISCUSSION: Males and patients participating in sporting activities had the best results and none of the patients had recurrent instability despite new sport injuries. The persistence of some pain may be associated with the long period of instability prior to reconstruction in this group of patients. CONCLUSION: The Chrisman Snook lateral ligament reconstruction is a technically easy and solid technique and we recommend it in patients with significant chronic lateral ligament instability.

[Surgical anatomical study of the spinal nerve]. / Contribution à l'étude anatomique chirurgicale du nerf spinal.

100 dissections performed in the Anatomy Laboratory have made it possible to clarify certain details relating to the cervical trajectory of the accessory nerve (traditionally called the 11th or spinal nerve), its relationship with the jugular vein, with the S.C.M. muscle, its position on the anterior and posterior edges of the S.C.M. and on the anterior edge of the trapezius muscle, and the frequency of its branching in the sub-clavicular fossa.

Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review.

BACKGROUND: Combined injuries to the posterolateral corner and cruciate ligaments are uncommon. The heterogeneity of injury patterns in many studies complicates the assessment of outcomes. OBJECTIVE: To assess the prognosis and functional outcomes after surgery for combined injuries to the posterolateral corner and to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL). MATERIAL AND METHODS: We systematically reviewed the literature for articles reporting outcomes 1 year or more after surgery for combined injuries to the posterolateral corner and ACL (n=4) or PCL (n=9). Patients with bicruciate injuries were not studied. RESULTS: Overall, 65% of patients were IKDC A or B after surgery. The mean Lysholm score improved from 67 to 90. Mean time to surgery was 4.43 months in the group with ACL tears and 18.4 months in the group with PCL tears, and mean follow-up was 34.4 and 40.7 months in these two groups, respectively. In the groups with ACL and PCL tears, the proportions of patients classified as IKDC A or B at last follow-up were 81.6% and 81.0%, respectively, whereas 88% and 99% of patients, respectively, were IKDC grade C or D before surgery. The mean Lysholm score improved from 77 to 92 in the group with ACL tears and from 65 to 89 in the group with PCL tears. Improvements in laxity ranged from 28% to 79% in the group with PCL tears. DISCUSSION: Most of the articles selected for our review provided level III or IV evidence. Functional outcomes were satisfactory but less good than those reported after surgical reconstruction of isolated cruciate ligament tears. Full reconstruction seems the best strategy in patients with combined ACL/posterolateral corner injuries. Outcomes were also good but more variable in the group with PCL/posterolateral corner injuries. The time to surgery, which reflected the time to diagnosis, was shorter in patients with ACL than with PCL tears in addition to the posterolateral corner injury. LEVEL OF EVIDENCE: Level III (systematic literature review).

Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results?

INTRODUCTION: Management of combined anterior or posterior cruciate ligament and posterolateral corner tears is still poorly codified. The aim of this study was to evaluate functional outcome after complete surgical treatment. MATERIALS AND METHODS: This retrospective multicenter study included 53 patients. Mean age was 29.8 yrs. (15-49). The anterior and posterior cruciate ligaments were involved in respectively 48 and 5 cases. Mean time to surgery was 25.6 months (0-184), and in 10 cases less than 21 days. Nine patients were sedentary workers and 29 non-sedentary (13 laborers). All ligament injuries were treated surgically. Mean follow-up was 49 months (12-146). Last follow-up assessment used IKDC, Lysholm and KOOS scores. RESULTS: At last follow-up, IKDC score graded 14 patients A, 25 B, 8 C and 6 D, versus 0 A, 4 B, 25 C, 22 D and 2 ungraded preoperatively. Mean subjective IKDC and Lysholm scores were respectively 72.8 (11.5-100) and 77.5 (37-100). Mean KOOS scores (pain, symptoms, daily life, sports, quality of life) were respectively 78 (3-100), 70 (25-100), 88 (47-100), 53 (0-100) and 50 (0-100). Posterolateral laxity was corrected in all but two cases. All sedentary workers and 86.7% of non-sedentary workers could return to work. The job had to be changed in 10% of cases overall, but in 25% of cases for laborers. DISCUSSION: The present results are comparable with those of the literature. The strategy of combined surgical treatment showed functional efficacy, usually associated with return to work except for some laborers. There was a non-significant trend in favor of acute-phase ligament reconstruction. LEVEL OF EVIDENCE: IV (retrospective series).

The current state of introduction of HPV vaccination into national immunisation schedules in Europe: results of the VENICE 2008 survey.

Three surveys have been undertaken in European Union (EU) member states since January 2007, within the European Commission funded Vaccine European New Integrated Collaboration Effort (VENICE) project, to monitor the decision status regarding the introduction of human papillomavirus (HPV) vaccination into national immunisation schedules. A web-based questionnaire was developed and completed online by the 28 countries participating in VENICE. According to the last update (31st December 2008), 15 countries have decided to introduce HPV vaccination into their national immunisation schedule, while another six have started the decision-making process with a recommendation favouring introduction. Varying target populations have been selected by the countries which have introduced vaccination. The number of countries which have made a decision or recommendation has increased from 12 to 21 between October 2007 and December 2008. This survey demonstrates the rapidly evolving nature of HPV vaccine introduction in Europe. A further update should be available in the second half of 2009.

[Contribution to the study of the origin of the phrenic nerve (nervus phrenicus). Apropos of 100 dissections of the cervical plexus]. / Contribution a l'étude de l'origine du nerf phrénique (nervus phrenicus). A propos de 100 dissections du plexus cervical.

After recalling the descriptions of classical authors, 100 dissections conducted to the study of the origin of the phrenic nerve (nervus phrenicus). It appears as variable and asymetrical. The presence of an accessory phrenic nerve has been rarely seen. The classical proximal anastomoses of this nerve are inconstant or rare.

A note on the anastomoses between the hypoglossal nerve and the cervical plexus.

A series of 80 dissections was performed to define the anastomoses between the cervical plexus and the hypoglossal nerve (XII), the superior anastomosis between the trunk of XII and the ansa of the atlas from the cervical plexus; the ansa cervicalis, traditionally known as the ansa of the XIIth cranial nerve or hypoglossal ansa, formed by the direct junctional anastomosis of the descending branch of XII and the internal descending branch of the cervical plexus. The origins, form, branches and chief relations are defined in in the present study.

A contribution to the study of the accessory nerve: surgical implications.

The anatomy of the accessory n. is defined in the light of 100 dissections with particular regard to the following aspects: its relations with the internal jugular v.; its participation in the innervation of the sternocleidomastoid m.; its location in relation to the anterior and posterior borders of that muscle and to the anterior border of the trapezius; and its branching and anastomoses in the supraclavicular fossa.

The nerve loops crossing below the subclavian artery and their anatomical variations.

60 dissections analysed the variability of three types of nerve loops crossing beneath the subclavian artery : Vieussens' annulus, the anastomotic ansa between the lower laryngeal nerve and the cervical sympathetic, and the anastomotic ansa between the phrenic nerve and the stellate ganglion. The classic disposition of these loops, situated below the artery and present simultaneously, was found in only 10% of the cases. Though Vieussens' annulus was present in most of the dissections, the anastomotic ansa between the cervical sympathetic and both the lower laryngeal nerve and the phrenic nerve corresponds more rarely to the conventional pattern.

A contribution to the study of the innervation of the sternocleidomastoid muscle.

Studies on the innervation of the sternocleidomastoid muscle have shown the highly variable arrangement of the nerve fibers originating from the accessory nerve (eleventh cranial pair) and cervical nerves which supply the muscle. The results of 100 dissections described in this study confirmed these variations and led to propose a classification of the innervation of the sternocleidomastoid according to three main types. The classical "anastomotic" type of innervation (also referred to as Maubrac's type of innervation) was the most frequent, although present in only half of all cases. Innervation of the sternocleidomastoids in symmetrical fashion was an exceptional finding. The functional attributes of these anatomical variations are discussed.