[TSH, FT4 and T3T evaluation in normal and preterm hospitalized newborns]. / Evaluation des taux de TSH, T4L, T3T des nouveau-nés prématurés et à terme hospitalisés.

UNLABELLED: Thyroid hormones are essential for foetus and newborn development. Preterm newborns present low levels for thyroid hormones. These low levels are related with disorder in psychomotor and neurological development. In the literature, several studies concerning newborns treated with thyroid hormone have been realized in different conditions; however, there is no consensus about preterm newborn supplementation benefit. OBJECTIVE: The aim of the study was to defined hormonal values used for normal and preterm newborns. MATERIAL AND METHODS: We reported TSH, T3T and T4L levels for 195 normal or preterm newborns, eutrophic or small for gestational age (SGA). RESULTS: A positive correlation was found between hormonal level and gestational age. This work allowed us to define a threshold for preterm newborn according to their gestational age. CONCLUSION: Owing to lack of consensus, those values are useful for clinical and biological follow-up of thyroid function for newborns at risk (SGA and preterm before 32 weeks) during the first year of life. Finally, it would be interesting to study systematic supplementation of thyroid hormone for those infants in a prospective study.

[Anatomic danger of percutaneous section of the inter-metatarsal ligament for the treatment of Morton's neuroma]. / Dangers anatomiques de la section percutanée du ligament inter-métatarsien dans le traitement du névrome de Morton.

Certain authors have proposed percutaneous neurolysis of Morton's neuroma. We conducted a human anatomy study to assess the reliability and the iatrogenic effect of percutaneous section of the ligament. Percutaneous section of the inter-metatarsal ligament was performed on 16 fresh cadaver specimens via a dorsal approach. The plantar dissection demonstrated that the section was not complete, without associated lesion, in only six cases. Analyzing these failures, we determined the necessary procedure for correct section.

[Squamous-cell carcinoma and osteomyelitis: three cases and a review of the literature]. / Epithéliomas épidermoïdes et ostéomyélites chroniques: à propos de 3 cas et revue de la littérature.

Chronic osteitis and squamous-cell carcinoma is a rare but classically described association. We report three cases of chronic tibial osteitis which developed open leg trauma. During the surveillance, after a latency period of several years, local signs developed leading to biopsy which provided the diagnosis of degenerative carcinomatosis. Search for locoregional extension or metastatic dissemination was negative. All three patients underwent amputation with good results. This small series, together with a review of the literature, enabled us to describe the principle epidemiological and diagnostic features, focusing on early signs. The appropriate management scheme remains to be determined although amputation, which some may consider as a failure, should not be postponed indefinitely.

[Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement]. / Etude prospective comparant la voie postérieure minimale invasive versus voie postérieure standard sur prothèse totale de hanche de première intention.

PURPOSE OF THE STUDY: There have been few prospective studies comparing minimally invasive approaches for total hip replacement. We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the standard posterolateral approach in terms of early outcome. MATERIALS AND METHODS: This was prospective comparative consecutive series of patients. Patients with major architectural problems or undergoing revision arthroplasty were excluded. One hundred ten patients (116 hips) were divided into two groups which were comparable for number of patients, gender, age, body mass index, indication for surgery, and preoperative function scores. The preoperative ASA score was lower in the minimally invasive group (p=0.04). The patients were in the lateral reclining position for the two approaches and classical instrumentation using the same implants (stems and cemented or non-cemented cups) were used. We noted operative time and blood loss (using the Brecher method based on the hematocrit at day 1 and 5 and the number of blood transfusions), postoperative pain, and implant position. Functional outcome was assessed with the modified Harris score and the WOMAC index (at 6 weeks and 3 and 6 months). Statview(R) was used to search for statistical significance considering p<0.05 as significant. RESULTS: Mean length of incision was 8.5 cm versus 15.1 cm. Mean blood loss was significantly less in the minimally invasive group (p=0.027) as was the level of postoperative pain as confirmed by the lesser consumption of morphine analgesics (p=0.006). Other operative variables as well as implant position were comparable. There were no major complications in the minimally invasive group. In the standard group, there was one case of common peroneal nerve palsy, two dislocations, and two fractures related to falls after prosthesis implantation. The WOMAC index was better after the minimally invasive approach at six weeks and at three months (p<0.05). The modified Harris score was better only at six weeks. Functional outcome and pain became comparable thereafter. DISCUSSION AND CONCLUSION: The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation. A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding. It enables satisfactory reproducible implant positioning. Conversion to an open posterolateral approach is possible if needed. The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation. Early clinical outcome is better but beyond six weeks, the functional results are comparable for the two approaches. The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve.

Micronutrient levels in HIV-1-infected children.

OBJECTIVE: Micronutrients (zinc, copper, selenium, vitamin A, E, and carotenoids) are essential for the integrity of host defences. This study was designed to determine the prevalence of abnormalities of the micronutrient levels in HIV-1-seropositive children. DESIGN: Prospective study. SETTING: The study was performed on HIV-1-infected children at the Paediatric Haematology and Oncology Unit of Toulouse Hospital, France. PATIENTS: Twenty-one children, suffering from HIV-1 infection and 21 control subjects of similar age (2-9 years) were included in the study. In the HIV-1-infected children, two subgroups were considered according to stage (non-AIDS or AIDS), based on the Centers for Disease Control and Prevention 1987 criteria. RESULTS: The first statistically significant deficiencies occurred at non-AIDS stage and were confirmed at AIDS stage: P < 0.05 for lycopene, retinol, tocopherol and P < 0.001 for transthyretin and serum albumin. Levels of copper (40%) and long-chain polyunsaturated fatty acids (21%) were higher in the non-AIDS group than the controls. CONCLUSION: Biological impairing of the micronutrient levels was observed in the non-AIDS stage without clinical sign. This information is useful in delineating eventual and well considered nutritional intervention strategies that may improve the clinical status of HIV-1-infected children and perhaps alter the course of their disease.

Evaluation of male sexual function after pelvic trauma by the International Index of Erectile Function.

OBJECTIVES: To assess the multifaceted male sexual function after pelvic ring fracture. METHODS: A cross-sectional study of male sexual function after pelvic ring fractures was conducted, using the International Index of Erectile Function (IIEF). The department of traumatology database was scanned (June 1996 to April 1999) for 30 to 70-year-old male patients with pelvic fracture. Seventy-six consecutive, literate patients were then contacted by mail. IIEF domain scores were calculated for all responders. Cappelleri's method for identification and grading of erectile dysfunction was applied for patients sexually active within the past 4 weeks. Student's t test was used to compare the domain scorings of patients with those of the control population used for the IIEF psychometric validation. Relationships between IIEF results and patient characteristics were sought by Spearman's rank correlation coefficient for quantitative variables and Student's t test for classes. RESULTS: Forty-six patients answered (60.1% response rate). Thirty-seven patients had experienced sexual intercourse in the past 4 weeks during which 11 patients (29.7%) had exhibited various degrees of impaired erection. As a whole, compared with the published controls a significant decrease in overall satisfaction (P <0.05) was demonstrated. Pubic diastasis was further related to impaired erectile function and overall satisfaction; we suggest that cavernosal nerves might be damaged at the time of diastasis. CONCLUSIONS: This study evidenced the impairment of sexual overall satisfaction after pelvic trauma and the specific decrease in erectile function and erection firmness and confidence associated with pubic diastasis. The IIEF questionnaire might be considered at the time of rehabilitation to identify those patients that could benefit from supportive treatments.

Assessment of the unstable shoulder by computed arthrography. A preliminary report.

The evaluation of 10 patients with subluxing and dislocating shoulder is presented. Routine radiography with special views detected the presence of Hill Sachs lesions in seven patients, but was not conclusive for three patients. Soft tissue and bone anomalies were documented by computed arthrography in all 10 patients. Computed arthrography represents a valuable tool in the diagnosis of obscure unstable shoulders.

Influence of pregnancy on human immunodeficiency virus disease.

Over a period of 3 years (mean 16, extremes 3 and 36 months), we compared clinical and laboratory parameters of 128 female, human immunodeficiency virus (HIV)-infected patients, all in clinical stage II or III (CDC classification). 34 patients were pregnant and delivered a viable infant after at least 28 weeks of amenorrhea (group I), 29 patients were pregnant and had a spontaneous or induced abortion during the first or second trimester (group II), and 64 were non-pregnant female control patients (group III). The changes in the clinical stages over time were not statistically significant between the groups. The only laboratory parameters that were significantly higher in group I at the time of the delivery were: leucocyte count (p less than 0.001), lymphocyte count (p less than 0.05), and sedimentation rate (p less than 0.001). These changes are known to be related to pregnancy and not to HIV disease. All other laboratory parameters showed no significant differences within and between the groups. We conclude, that pregnancy--carried to term or interrupted--does not aggravate the natural evolution of HIV infection in clinical stage II and III patients.

Familial cystic hygroma. Report of 8 cases in 3 families.

The authors report 8 cases of familial cystic hygroma concerning 3 families. In the first family, the two affected fetuses with normal karyotypes showed cystic hygroma of the neck associated with campomelic long bone disease. No other fetal anomalies in the two fetuses were found in the second family, and only one of the four abortuses revealed associated malformations (meningomyelocoele, cleft palate) in the third family. In all these cases, parental consanguinity is found, supporting an autosomal recessive mode of inheritance.

22q11 deletion in DGS/VCFS monozygotic twins with discordant phenotypes.

22q11.2 deletion is a common genetic disorder characterised by a wide spectrum of clinical manifestations. To date no simple genotype-phenotype correlation has been established. Moreover, several reports have mentioned phenotypic discordance between monozygotic twins. No definite mechanism has been demonstrated and mosaicism, a postzygotic second hit, environmental effects and chance events have been proposed. The twinning process itself has been suspected in two cases (11, 23). We report the case of monozygous twins with a 22q11.2 deletion who are discordant for a heart defect. We found no arguments for mosaicism or twin-to-twin transfusion syndrome. The frequent discordance for heart defects in DiGeorge/Velo-cardio-facial syndromes (DGS/VCFS) does not favour the hypothesis of somatic mutations contributing to the phenotypic variation, but rather a complex interaction between genetic and environmental systems.

[Angiocardiographic study of obstructive cardiomyopathies. Attempt to evaluate the role of the interventricular septum and the great mitral valve in the obstructive phenomenon]. / Etude angiocardiographique des cardiomyopathies obstructives. Essai d'évaluation du rôle du septum interventriculaire et de la grande valve mitrale dans le phénomène obstructif

Images of the left ventricles, taken in two planes at ventriculography in 45 established cases of obstructive cardiomyopathy, were subjected to a special type of analysis which allowed certain sectional and angular measurements to be made. In particular we calculated and end-systolic index of obstruction, and two measures of the contribution of the septum and the mitral valve to the subaortic obstruction. It then proved possible to study the part played in the stenosis by the interventricular septum and the mitral valve respectively, and to classify the obstructive cardiomyopathies by these criteria. The orientation of the sigmoid floor also seems to play a vital role in determining the dominance of the septum or the mitral valve. These three factors, when examined together, allow us to conclude that there are fixed factors which determine the existance of obstructive cardiomyopathy, to calculate the degree of mitral contribution to the obstruction, and to realise that the orientation of the sigmoid floor helps us to distinguish the type of obstruction. The combination leads to an angiocardiographic classification of the obstructive cardiomyopathies, and the prognostic and surgical significance of this classification are discussed.

[Closure of sternotomy with Cotrel staplers]. / Fermeture des sternotomies à l'aide des agrafes de Cotrel.

The authors describe a new method for the closure of median sternotomies based on immediate compression with two or three Cotrel-Dubousset (CD) staples. This method was effective in a series of 100 patients. It was the curative treatment of septic sternal pseudarthrosis, and has been extended to high risk patients (age, severe sternal osteoporosis, obesity, diabetes, chronic respiratory insufficiency) or when surgery requires resection of the internal mammary arteries (IMA).

[Congenital erythropoietic porphyria. Apropos of a fatal case in the neonatal period due to acute hemolysis with hepatic failure]. / Porphyrie érythropoïétique congénitale. A propos d'un cas fatal en période néonatale dû à une hémolyse aiguë avec insuffisance hépatique.

BACKGROUND: Congenital erythropoietic porphyria, an autosomal recessive disease, is characterized by deficiency of uroporphyrinogen III synthase. Clinical variability of the disease is related to the different mutations found in the patients. CASE REPORT: A newborn suffered one hour after birth from jaundice and polypnea with acute hemolysis. Severe cutaneous photosensitivity occurred after phototherapy. Congenital erythropoietic porphyria was suspected because of reddish-colored urine and confirmed by porphyrin analyses. The baby died one month later due to severe hemolytic anemia with hepatic failure. Uroporphyrinogen III synthase activity was decreased by 99% in bone marrow cells and established lymphoblastoid cells from the patient. Molecular biology studies demonstrated the presence of the Cys 73-->Arg substitution at the homozygous state in the patient. CONCLUSION: This mutation, the most frequently found in this disease, is responsible for a severe phenotype. Molecular characterization provides genotype/phenotype correlations in this porphyria and allows to clarify unusual cases of porphyrias.

[Study of breast cancer by means of liquid crystals thermography]. / Etude du cancer du sein par la thermographie clinique. Thermographie en plaque

Liquid crystals thermography allows a very precise study of breast cancers. It is particularly important for diagnosis of very small tumors and for follow-up of irradiated breasts. It gives pronostic and therapeutic information.

[Prophylactic cesarean section and HIV seropositive patients]. / Césarienne prophylactique et patientes séropositives pour le VIH.

OBJECTIVES: HIV infection among children is essentially related to perinatal transmission. It seems the contamination occurs late in the pregnancy or during the labor. The benefits of cesarean section in HIV-infected women has to be examined. STUDY DESIGN: A retrospective survey of all deliveries of 292 HIV-infected women, of the newborns and of the impact of different ways of delivery on transmission risks. 164 women had a pregnancy lasting more than 28 weeks, 27 underwent a cesarean section. RESULTS: 22.2% of patients who underwent a cesarean section contaminated their child, 25.2% among vaginal deliveries. No significant association was found between HIV transmission and delivery mode. CONCLUSION: We outline the necessary elements for the conduct of a conclusive efficacy trial of operative versus vaginal delivery.

[Thermography of the testicle. Preliminary study]. / Thermographie du testicule. Etude préliminaire

The preliminary study is concerned with 25 cases that have been examined using thermography in planes to check the conditions of temperature of the testes in normal and pathological states. Normal testicular thermography is characterised by a symmetrical and constant thermographic picture, the temperature staying between 32.5 and 34.5 degrees. In the pathological states of oligoasthenospermia plate thermography shows up a particular thermic picture associated with a varicocoele whether this is clinical or subclinical. The picture is one of hyperthermia and lack of symmetry in the case of a unilateral lesion. In these cases tyeing off the spermatic vein shows a rapid return to a normal thermographic picture. These positive results have led to a more extensive and deep study which is at present in progress.

[Proximal fibulo-tibial dislocation and ischemia associated with a leg fracture. Apropos of 2 cases]. / Luxation péronéo-tibiale supérieure et ischémie associées à une fracture de jambe. A propos de 2 cas.

Proximal fibulotibial dislocation may remain escape detection in leg injuries. Posterior dislocations are unusual and are associated with shortening of the limb due to the tibial fracture. Two cases of such dislocation are reported, associated with lower limb ischemia due to an injury of the arterial popliteal trifurcation. An anatomical model indicates the mechanism of this lesion. Such an unusual association has not be found elsewhere in literature.

[Lymphoscintigraphy and internal breast curettage in breast cancer. Comparison of results. 32 cases]. / Lymphoscintigraphie et curage mammaire interne dans le cancer du sein. Confrontation des résultats. 32 observations.

Thirty-two women with breast cancer considered in active phase underwent, successively: internal mammary lymphoscintigraphy with 99m rhenium sulfide, chemotherapy and Pathey-type mastectomy with dissection of the axillary and internal mammary lymph nodes. Lymphoscintigraphy was successful in 97% of the cases, without complications. Its specificity was 0.88 (range: 0.76--0.99) and the sensitivity 0.6 (range: 0.19--0.92). Internal mammary lymph node dissection was technically successful in 87.5% of the cases; one patient developed chondritis. Thus, lymphoscintigraphy is usually successful, without morbidity and specific. However, it cannot pretend to provide a complete answer, as does internal mammary producing invaded lymph nodes.