[Hand allografts: experience from Lyon team]. / Allogreffe de mains: expérience lyonnaise.

Hand allograft is a method in the stage of clinical experimentation, which is reserved in France for the treatment of bilateral traumatic amputees. This study reports the Lyon team experience, which is pioneer in this domain. Four patients (3 males and 1 female) underwent seven (one unilateral and three bilateral) hand transplantations from September 1998 to February 2007. The level of amputation was at the wrist or at the mid-forearm. Delay since hand loss ranged from 2.5 to 9 years. The surgical protocol was elaborated and planned case by case. All recipients received the same immunosuppressive treatment. Episodes of acute rejection were observed in the first 3 months after transplantation, which were easily managed after a few days increasing oral prednisone doses and applying topical immunosuppressants. Currently the patients receive the doses of immunosuppressants comparable to those in kidney-grafted patients. We have not registered any severe complication of immunosuppressive treatment up till now (7 years follow-up for the earliest graft). We performed analytical and functional clinical, as well as questionnaire evaluation of patients. The first case (unilateral graft) resulted in graft failure at 2 years due to non-compliance of the patient. The three bilateral graftees demonstrate a favorable evolution despite some immunological (hyperglycemia, serum sickness) and surgical (thrombosis, osteomyelitis, skin loss) complications, which could be managed. The middle and long-term follow-up evaluation revealed good to excellent sensorimotor recovery of 4 hands in both male recipients (4 and 7 years) with satisfactory social adaptation, higher or equal to those expected after post-traumatic replantations at the equivalent level and higher to those obtained with currently available myoelectric prosthesis. The last patient, a young female who has been grafted in February 2007, receives ongoing reeducation course and shows normal progress of functional restoration of both hands. The encouraging results of this clinical experimentation make us currently consider hand allografting as reasonable and useful both for the patients and for evolution of research in composite tissues allotransplantation (CTA). Further long-term careful research and worldwide monitoring of all patients with hand allografts is required to, on the one part, state on the authorization of this surgery, and, on the other part, to better elucidate the mechanisms of successful CTA.

[Magnetic resonance angiography of stents]. / Stents et angiographie par résonance magnétique.

PURPOSE: To understand the behavior of stents during contrast-enhanced magnetic resonance angiography (MRA). MATERIALS AND METHODS: Seven different types of stents are explored in vitro with spin echo (SE) T2 sequence and MRA sequences using classification of the intra-prothesis signal. Six patients with 11 different proximal stents are studied by Gadolinium enhanced MRA with the same classification. RESULTS: Stent material is not the only determinant of behavior. In this way, one stainless steel stent produced less intra-luminal hyposignal than a nitinol device. Nevertheless, only a nitinol stent did not alter the intra-prothesis signal and allowed an appreciation of patency, despite a decrease of diameter and presence of edge artifacts. CONCLUSION: Even if stent compatibility is well known with MRI, even with Gadolinium, cannot be used alone to depict stenosis or diameter reduction. Even patency based on the presence of a constant signal, cannot be confirmed routinely with confidence: indeed, only a single stent does not modify intra-arterial signal.

[Leg embolisms: treatment via surgical embolectomy]. / Embolies des membres inférieurs: traitement par embolectomie chirurgicale.

Arterial thrombembolectomy with the Fogarty balloon catheter was the standard therapy until now. We present fifty three patients who underwent 63 embolectomies. The rate of leg salvage was 95%, mortality was 18.8%. There is no controversy about the use of the Fogarty balloon catheter in the iliofemoral segment, particularly in patients with acute ischemia. In popliteal and tibial embolic occlusions, associated intraoperative fibrinolytic therapy obtained good results. Percutaneous thrombo aspiration was a complementary technique for few of distal embolic occlusions.

[Reverse endarterectomy of the internal carotid]. / Endartériectomie par retournement de la carotide interne.

We have described an original technique of eversion carotid endarterectomy which has been performed in two series of patients. In the first series the patients were operated on in Angers. They were 65 carotid stenosis in 56 patients with a mean follow-up of 27 months (18-36 months). In the later series, the patients were operated on in Lyon. They were 51 carotid stenosis in 43 patients with a follow-up from 1 to 24 months. The two series were comparable in term of symptoms and grade of stenosis as determined by duplex-scan and arteriography. The technique which has been previously described is safe and presents a lot of advantages over classical endarterectomy or vein graft. We observed no postoperative neurological deficit and no postoperative thrombosis. Two residual stenosis (1.7%) were measured at 30% but they did show any impairment during two years of follow up in the first series. Eversion endarterectomy of internal artery is a safe and deficient alternative to others techniques in the surgical treatment of atherosclerosis stenosis of internal carotid artery.