Glue mesh fixation in laparoscopic sacrocolpopexy: results at 3 years' follow-up.

INTRODUCTION AND HYPOTHESIS: We assessed 3-year anatomic and functional results using synthetic glue to fix mesh in laparoscopic sacrocolpopexy. METHODS: Prospective multicenter cohort study in three academic urogynecology departments. Seventy consecutive patients with stage ≥ 3 POP-Q (Pelvic Organ Prolapse Quantification) anterior and/or apical prolapse underwent laparoscopic sacrocolpopexy using synthetic surgical glue to fix anterior and posterior meshes to the vagina. Patients were followed up at 1, 2 and 3 years. Primary outcome was anterior and apical anatomic success (POP-Q stage ≤ 1) at 3 years. Secondary outcomes comprised functional results (international quality of life and sexuality scales), mesh-related morbidity and urinary incontinence at 3 years. RESULTS: Mean age was 56.7 ± 1.2 years. Mean follow-up was 43 months. Anterior compartment anatomic success rate was 87% at 2 years (Ba, -2.4 cm; p < 0.0001) and 86.5% at 3 years (Ba, -2.3 cm; p < 0.0001); apical success was 96.3% at 2 years (C, -6.8 cm; p < 0.0001) and 97.3% at 3 years (C, -6.5 cm; p < 0.0001). All quality-of-life scores improved significantly and lastingly at 3 years: PFDI-20, PFIQ-7 and PISQ-12, respectively, p < 0.0001, p < 0.0001 and p = 0.01. There was one case of vaginal mesh exposure at 3 years (2.8%) and five of mesh shrinkage at 1 year (7.8%), none at 2 years and two at 3 years (5.4%). Urinary incontinence rate was 29.7% at 1 year, 14.8% at 2 years and 11.1% at 3 years. CONCLUSION: Vaginal mesh adhesive in laparoscopic sacrocolpopexy remained effective at 3 years, with excellent tolerance and no specific complications. Anatomic and functional results were good and enduring in terms of both anterior and apical correction.

[The floating knee: a retrospective analysis of 172 cases]. / Le genou flottant: étude rétrospective de 172 cas.

A retrospective multicentric observational study of 172 floating knee injuries is reviewed. According Fraser's classification 71.5% of the cases are type I and the repartition of the type II in the 3 subgroups is as follow: II A 8.2%, II B 11.6%, et II C 8.7%. At least one of the fractures was open in 69.2% of the patients. The average Injury Severity Score (ISS) was 19.5. The polytraumatized patients (ISS over 18) represented 37.7% of the cases. The surgical procedure started within the 6 first hours in 62% of the injured people. The Intramedullary nailing (IM) was the preferred method at the femur site (73%, 126 cases), at the tibia IM was performed in 54.4% of cases and external fixation was used in one every four patients. The mean operating time was 167 minutes (range: 40'-300') and the total time for the whole procedure was 216 minutes (range: 80'-410'). The mean follow up is 34.2 months. According the functional score of Karlström and Olerud, 23 patients were rated as excellent, 38 as good, 35 as fair and 20 as bad. The contributing factors influencing bad functional outcome are the age, a type II lesion, a femoral fracture located at the distal third, and an open fracture. The IM using a single knee incision does not show in this series better results but the shortening of the operating time was highly significant.

Balloon humeroplasty reconstruction for acute Hill-Sachs injury: A technical note.

Posterior Hill-Sachs humeral defects are present in 80% to 100% of cases of anterior shoulder dislocation and are a factor in recurrent instability. Several techniques have been described to fill the defect and avoid recurrence. We developed a percutaneous technique to fill the newly created defect in which a percutaneous balloon, analogous to the one used in vertebral kyphoplasty, is used to reduce the defect, which is then filled with calcium phosphate cement. One patient with an acute anterior dislocation of the shoulder with no previous history was treated using this method. Early imaging results showed adequate reduction of the defect and no cement resorption. The patient was followed for 12 months; he had normal function of the shoulder and no recurrent dislocation. Shoulder computed tomography (CT) arthrography with contrast after 3 months showed an intact capsule and no recurrence of the defect. While this technique is certainly in its infancy, we have demonstrated that emergency reduction of the defect in acute first occurrence anterior shoulder dislocation is feasible, helps to restore normal anatomy of the humeral head and leads to good clinical results. Whether it can improve clinical results and prevent recurrent shoulder dislocation remains to be evaluated.

[Assessment of a matrix-based quantitative ultrasound imaging device (Beam scanner): reproducibility]. / Evaluation d'un appareil quantitatif ultrasonore utilisant des matrices (Beam scanner): reproductibilité

PURPOSE: A new matrix-based quantitative ultrasound (QUS) device was developed for the assessment of two parameters: BUA (Broadband Ultrasound Attenuation) and SOS (Speed Of Sound). This device, called Beam scanner, is a contact imaging device designed to evaluate the calcaneus. The aim of this preliminary study was to evaluate the reproducibility of results in a sample of patient with heterogeneous age distribution. MATERIALS AND METHODS: Seventy-six subjects were included: 18 healthy young males, 18 healthy young women and 40 women aged over 50 years old, including 19 osteoporotic patients according to WHO criteria. Five measurements were made for each patient after foot repositioning. Short-term precision was estimated using the coefficient of variation (CV), standardized CV (SCV) and intra-class correlation coefficient (ICC). RESULTS: SCV varied with the group of subjects between 2.0 and 4.3% for BUA, and between 3.1 and 4.5% for SOS. Mean values of BUA and SOS were statistically lower for osteoporotic women compared with healthy young women or healthy young males (p<0.001). For BUA, only SCV and ICC were better for women aged over 50 years old but without statistical difference. CONCLUSION: This study shows that the heterogeneity of the studied sample population is not a significant factor when assessing precision. This new device has a precision similar to others QUS devices.

Different effects of yohimbine and idazoxan in the light-dark choice procedure.

In a light-dark choice situation, the alpha(2) adrenoceptor antagonists yohimbine and idazoxan had different effects: idazoxan decreased time spent in the fit box, but yohimbine did not. The effects of idazoxan were not blocked by the alpha(2) adrenoceptor agonist clonidine. The benzodiazepine receptor antagonist Ro 15-1788 itself decreased time spent in the lit box, but in the presence of Ro 15-1788, idazoxan did not cause any further reduction.

Anxiogenic-like effects of yohimbine and idazoxan in two behavioral situations in mice.

In a light-dark choice situation, the alpha-2 adrenoceptor antagonist idazoxan shows anxiogenic-like effects, which cannot be blocked by the alpha-2 adrenoceptor agonist clonidine, or by the benzodiazepine receptor antagonist Ro 15-1788. In a conditioned conflict situation, both idazoxan and the alpha-2-adrenoceptor yohimbine show anxiogenic-like effects; the effect of idazoxan could not be blocked by clonidine or Ro 15-1788. These data suggest that systems other than alpha-2 adrenoceptors or benzodiazepine receptors must be found to explain these anxiogenic-like properties.

Biodegradation of the (aliphatic + aromatic) fraction of Oural crude oil. Biomarker identification using GC/MS SIM and GC/MS/MS.

A simplified fraction of the Oural crude oil (aliphatic and aromatic hydrocarbons) was incubated in the presence of an hydrocarbonoclastic bacterial community isolated from a marine sediment highly contaminated by petroleum residue. The biodegradation has been carried out under aerobic conditions for 5 weeks and followed by FTIR, UV synchronous luminescence and GC/FID. Disappearance of the n-alkanes (2nd week), an important attack of the isoprenoïd compounds (5th week) and preferential alteration of monomethylated polyaromatics were observed. Concerning the biomarkers, the bicyclic alkanes and pentacyclic terpanes have been comparatively elucidated using GC/MS data. The identification of C(26) to C(29) steranes has required a most selective method, namely GC/MS/MS. Many molecular ratios based on GC/MS abundances were calculated, which showed good stability. Consequently, they can be used to determine the origin of a petroleum even one altered by biodegradation.

New approach to study of spilled crude oils using high resolution GC-MS (SIM) and metastable reaction monitoring GC-MS-MS.

Polycyclic aromatic hydrocarbons (PAHs) and geochemical biomarkers are good environmental markers to study the origin and evolution of an oil spill. To have access to the greatest number of molecular ratios, no fractionation of oil into aliphatic and aromatic compounds is made. Three analytical MS approaches are tested to analyze markers in this total hydrocarbon fraction: classical quadrupole GC-MS, high resolution GC-MS (HR GC-MS) and metastable reaction monitoring GC-MS-MS (MRM GC-MS-MS). This analytical approach is used to follow the evolution of PAHs in petroleum polluted mangrove soils over 8 years by using molecular ratios between polycyclic aromatic hydrocarbons and tri- and tetracyclic terpanes.

[The psychology of chronic rheumatism patients based on the Rorschach test]. / Psychologie des rhumatisants chroniques à travers le test de Rorschach.

The objective of this research was to try to see if it was possible to find in a population of chronic rheumatickies (a great majority of P.C.E.) some specific psychologie characteristics or constants among these sicks. So we have used Rorschach test. On the based of 19 persons inspected, we have found 84% who present a pathological inhibition and 68% a pathological anxiety. They are datums more strikingness, but we have found others interesting indications. For example: 47% persons presented symptoms of a affectivity no stabilize egocentric and impulsive and had a perturbed thought by their affectives problems. 21% a deficient valuation of reality. We have terminated trying to discuss two others questions from datums collected.

[Deflected cephalic presentation. Apropos of 80 cases]. / Les présentations céphaliques défléchies. A propos de 80 observations.

Between 1974 and 1986, we have observed 80 deflected cephalic presentations in the Maternity of Hopital Edouard Herriot in babies weighing more than 2,000 g. They are divided in 34 brow presentations, 27 faces and 14 Bregma. The diagnosis was often made late. Caesarean section is the rule in brow and mento-posterior face presentations. There was no fetal trauma.

Reducing the cervical flexion tear-drop fracture with a posterior approach and plating technique: an original method.

Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. We therefore hypothesized that reduction would be possible by acting on the articular process through a posterior approach with a particular plating technique. Eight patients with FTDF were operated on with the technique we describe. Three had complete tetraplegia, four had incomplete tetraplegia and one was normal. A preoperative CT scan was made in all patients. Local kyphosis, posterior displacement of the vertebral body, and general lordosis in the cervical spine were recorded. In all cases, a satisfactory reduction was achieved on the postoperative radiographs and at the mean follow-up of 18.6+/-12.1 months, with residual posterior displacement being less than 1 mm. No complication occurred. Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.

Traumatic total axial reversal of the thoracic vertebral body.

Numerous vertebral fracture patterns have been reported in the literature. We present the case of a patient who sustained severe trauma to the back that resulted in a very unusual and not previously reported rotational injury consisting in complete 180 degrees rotation of the T6 vertebral body along a vertical axis, with only limited anteroposterior and lateral displacement. An unsuspected aortic tear resulted in severe evolution with fatal outcome following surgical attempt. The aetiology of such displacement is unknown. The possibility of late vascular complications should be kept in mind while treating thoracic spine fractures with rotational displacement.

Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease.

There are very few studies with more than 20 years' follow-up of lumbar spine fusions for disc degeneration. Currently, there is a lot of interest in the subject of degenerative changes above the level of fusion; this study is concerned with such changes in the very long term (30 years). Twenty-eight patients showing sound fusion on radiographs following posterior midline spinal fusion performed by a single surgeon between 1968 and 1970 were compared with an age- and gender-matched group of 28 patients who had undergone surgery for degenerative disc disease without fusion during the same period, by the same surgeon and using similar criteria for evaluation (Short Form 36 and Oswestry Disability Index; functional testing using self-paced walk and timed up-and-go; flexion and extension lateral radiographs of the lumbar spine). In this study, the incidence of radiographic changes at levels above the level of previous involvement was twice as high in the fusion group as in the non-fusion group. However, there was no statistically significant difference between the two groups in the outcomes measured using validated scales and functional testing. The study emphasises the importance of complete evaluation of these patients using validated outcome measurement instruments against the background of radiographic changes and subjective assessment of back pain. It also shows that radiographic changes do not necessarily mean functional impairment in all patients following lumbar spine fusion for degenerative disc disease.

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period.

Concomitant traumatic injuries in the upper cervical spine are often encountered and rarely reported. We examined the data concerning 784 patients with cervical spine injuries following trauma, including 116 patients with upper cervical spine injuries. Twenty-six percent of patients with upper cervical spine injuries (31 cases) were found to have combined injuries involving either the upper or the upper and lower cervical spine. The frequent patterns were combined type I bipedicular fracture of the axis and dens fracture, and combined dens fracture and fracture of the posterior arch of C 1. Other patterns posed specific problems, such as combined dens and Jefferson fracture and combined dens and C2 articular pillar fracture. Seventy percent of atlas fractures, 30% of C2 traumatic spondylolistheses and 30% of dens fractures were part of a combination. A total of 1.7% of patients with lower cervical spine injuries had a combined injury in the upper cervical spine. A comprehensive therapeutic schedule is outlined. Combined injuries in the upper cervical spine should be sought in any patient with a cervical spine injury.