A simple surgical treatment for acute traumatic sternoclavicular dislocation.

Sternoclavicular lesions may sometimes require surgery. Many techniques have been described and they appear to be very demanding. We describe a simple technique using two screws and a strong suture (Arthrex Inc. Naples. FL 34108 USA). Level of evidence; Level IV, Case Series, Treatment Study.

[Imaging of anorectal malformations in the neonatal period]. / Imagerie des malformations anorectales en période néonatale.

PURPOSE: The classification of anorectal malformations (ARM) as high or low is based on clinical and anatomical characteristics. It has an impact on the surgical management but also on the functional prognosis. In the absence of consensus, our goal was to determine the value of imaging in the neonatal period for diagnosis and management of infants with ARM. MATERIALS AND METHODS: Retrospective study of 43 infants imaged over a 9 year period. The different imaging studies (abdominal and pelvic ultrasound, radiographs, percutaneous opacifications and fistulograms) performed for each infant were collected and analyzed then correlated to clinical and surgical findings. RESULTS: Clinical evaluation could classify 30 ARM as low and 4 ARM as high while 9 ARM without fistula remained indeterminate. Imaging findings were mixed: on ultrasound, the rectal cul-de-sac to perineum distance did not appear to be determinant, contrary to published data. Pelvimetry showed limitations, irrespective of the technique. Morphological evaluation provided the following data: presence of fistula, sphincter anatomy, rectal cul-de-sac to perineum distance. CONCLUSION: Classification relies on clinical evaluation in most cases. Opacification techniques and ultrasound remain useful in some cases. MRI could become the preferred imaging modality.

[Hepatic splenosis: a rare etiology of hepatic nodules]. / Splénose hépatique: une étiologie rare de nodules hépatiques.

Splenosis is the autotransplantation of splenic tissue, generally after traumatic splenic rupture. Usually, the peritoneal surface is affected. The viscera are rarely involved in this graft. We report a case of intrahepatic splenosis, which presented as a liver tumour on imagery in a 55-year-old man followed for lung carcinoma and chronic hepatitis C and who had undergone a splenectomy for trauma 22 years before. The different characteristics and diagnostic methods of 16 cases of hepatic splenosis are presented from the literature. These different reports emphasize the necessity of considering splenosis in the differential diagnosis of hepatic tumours.

[Volar fixed angle plate LCP 3.5 for dorsally distal radius fracture. About 24 cases]. / Ostéosynthèse antérieure par plaque à vis verrouillée LCP 3.5 dans les fractures de l'extrémité inférieure du radius à déplacement postérieur. A propos de 24 cas.

PURPOSE OF THE STUDY: Fracture of the distal radius with posterior displacement is the most common wrist fracture. Pinning is generally proposed. The problem is that a secondary displacement may persist, even for the least complex fractures. With the advent of the fixed-angle plate with a self-locking screw, we considered using this method in combination with an anterior approach to the radius. We report our preliminary results. MATERIAL AND METHODS: From November 1 to March 31, 2003, among the 195 fractures of the distal radius with posterior displacement which we treated in our unit, 135 were treated with orthopedic reduction, 36 with Kapandji pinning and 24 with a T-shaped anterior locking compression plate (Synthès, LCP 3.5. During the early part of this series, the LCP was used for emergency situations in young adults with a posterior displacement exceeding 20 degrees . Starting in November 2002, the technique was also proposed for revisions for secondary displacements after orthopedic reduction or pinning procedures. Secondary displacement was noted on the standard X-rays and the clinical analysis included a measurement of muscle strength, the DASH score and the clinical evaluation score used by the SOFCOT symposium in November 2000. RESULTS: Twenty-four patients (14 female, 10 male, mean age: 54.5 years) presented 14 extra-articular fractures and ten articular fractures. At admission, mean frontal inclination of the radial glenoid was 13 degrees with a posterior displacement of 25.45 degrees and an ulnar variance measuring+4mm. Eighteen patients were reviewed at mean 16 months follow-up. Mean frontal inclination of the glenoid was 23.95 degrees with mean anteversion 5.45 degrees . Using the SOFCOT criteria, 11 outcomes were anatomic and seven presented moderate displaced healing. The wrist force (Jamar was 95% of the value measured on the healthy side. The mean DASH score was 38.47. Outcome was considered excellent for nine cases, good for six, fair for three and poor for zero. Complications were: reflex dystrophy (n=4), carpal tunnel syndrome (n=1), cheloid scar (n=1), glenoids in the pulse gutter (n=10), and secondary fracture along the upper border of the plate (n=3). CONCLUSION: This study demonstrated that, used on the anterior aspect of the radius, the locking compression plate provides satisfactory treatment for fractures of the distal radius with posterior displacement. Because of the angular stability, the reduction can be maintained over time so that secondary displacement is no longer a problem. This is a difficult technique which requires particular skill. We no longer recommend the LCP 3.5 plate due to the poorly adapted ergonometry, the late fracture over the plate and the fact that the material is not removed.

Training program for pain assessment in the newborn.

AIM: Pain management is correlated with pain assessment in the newborn infant. The aim of this study was to assess the impact of a 2-week training program composed of short (20min), repeated training sessions conducted in the unit. METHODS: Pain assessment was studied by means of audits. Each audit included data recorded from the newborn infant's medical charts on the day the infant was admitted to the unit and 3 days before the audit. An audit was performed before the training program and then repeated every month for 12 months. RESULTS: Eighty-eight (53.7%) members of the neonatology staff were trained during the 2-week training program. After the training program, pain assessment "at least once a day" increased by 39.0% and pain assessment "at least once a shift" increased by 21.5% compared to baseline (P<0.05). The effects of the training program were maintained after 12 months (P<0.05). CONCLUSION: A training program with short, repeated sessions conducted in the unit trained 53.7% of the neonatology staff and increased the frequency of pain assessment.

[Using the DRP 2.4 device for volar plating of distal radius for dorsally displaced wrist fractures. Report of 22 cases]. / Ostéosynthèse antérieure par plaque à tête de vis verrouillée DRP 2.4 dans les fractures à déplacement postérieur de l'extrémité distale du radius. A propos de 22 cas.

OBJECTIVE: Our first experience of palmar plating for dorsally displaced distal radius fracture with locking compression plate showed good results. But ancillary tools was ineffective, so we report our early experience with the DRP 2,4 device. METHODS: Between January and October 2004, 22 patients (16 women, 6 men), mean age 56,8 years (age range: 24-77 years), underwent internal reduction and fixation using DRP 2.4 by Henry's approach. By AO classification there was 10 A3 and 12 C1 or C2 fracture. On pre operative X Ray, radial inclination was 13.9 degrees , and dorsal tilt was 27 degrees . RESULTS: Seventeen patients were reviewed with mean follow-up of 11 months (5 to 17). On postoperative X Ray, radial inclination was 22,7 degrees and palmar tilt was 2,1 degrees. At 6 month radiological findings found no loss of postoperative reduction. According to SOFCOT's criteria's, we noticed 9 anatomical results and 8 moderate malunion. Clinical results (Green and O'Brien) showed 6 excellent, 7 good, 4 fair and no poor results. Mean DASH score was 13.5. Strength recovery was 82% of opposite side. Complications concerning 6 patients with, 4 reflex sympathetic dystrophy, and 2 screwdriver breakage during insertion. DISCUSSION: Volar plating with DRP 2.4 is an effective technique, but obtain anatomical reduction remind challenging for the surgeon. CONCLUSION: DRP 2.4 volar plating is an effective treatment for dorsally displaced fracture. Controlled study with orthopaedic reduction and K Wire fixation are need for determining the place of each treatment.

[Maternal anxiety related to how the pediatrician provided prenatal information about preterm birth]. / Évaluation de l'anxiété maternelle liée aux modalités d'informations sur la prématurité chez les patientes présentant un risque d'accouchement prématuré.

INTRODUCTION: Women hospitalized for preterm labor require clear information about prematurity. This study assessed whether or not specific written information about prematurity delivered at admission to the unit combined with an oral explanation from a pediatrician would decrease women's anxiety compared to an oral explanation alone. MATERIAL AND METHODS: This was a prospective, single-center observational study. Women were included in the high-risk pregnancies department and distributed into two groups: receiving "only oral" information for a prenatal clinical consultation with a senior pediatrician or receiving "combined" oral information+a booklet about prematurity given to the women at admission. The primary endpoint was the change in anxiety-state (before and after the information procedure) evaluated by the State Trait Anxiety Inventory-Y (STAI-Y). RESULTS: The anxiety score before receiving information did not differ between the two groups (STAI-Y-A "combined" group: 46.7±3.0 vs. "only oral" group: 42.7±2.74; P=0.55). After consultation with a pediatrician, the acute anxiety-state score STAI-Y-A decreased significantly in the "combined" group (-6.7±1.9) compared to the "only oral" group (-2.5±4.6; P<0.05). DISCUSSION: A booklet about prematurity combined with oral information from a pediatrician reduced patients' anxiety more than oral information alone. Given that the psychology of the mother interacts with the pregnancy, it is necessary to provide clear and adapted information. Giving a booklet appears to be one of the modalities to improve information. Other modalities such as video documents have to be studied.

Safety and tolerability of subcutaneous treprostinil in newborns with congenital diaphragmatic hernia and life-threatening pulmonary hypertension.

BACKGROUND: Prolonged pulmonary hypertension (PH) is highly predictive for pulmonary morbidity and death in infants with congenital diaphragmatic hernia (CDH). OBJECTIVES: To report the effects and tolerability of subcutaneous treprostinil in newborns with severe CDH and late life-threatening PH. METHODS: We recorded clinical and echocardiography data before and after starting subcutaneous treprostinil, on patients with severe CDH and late PH, refractory to inhaled nitric oxide and oral sildenafil. RESULTS: 14 patients were treated with treprostinil (gestational age: 39.1±2.0weeks; birth weight: 3200±600g). Prior to treatment, the pre- and post-ductal SpO2 difference (Δ SpO2) was 14±10%. Treprostinil was initiated at a median age of 12days [5-157]. After starting treprostinil, ΔSpO2 decreased to 3% at day 7 (p<0.05), and the mean blood flow velocities in the right pulmonary arteries increased by 110% (p<0.05). 2 of the 14 patients died. At the age of follow up (12months to 3years), the 12 surviving infants were all weaned from respiratory support and discharged home. CONCLUSION: The subcutaneous treprostinil improves pulmonary hemodynamics and outcomes in infants with CDH and life-threatening PH. We suggest that the treatment should be considered in infants with severe CDH and late PH. TYPE OF STUDY: Case series with no comparison group. LEVEL OF EVIDENCE: Level IV.

Innate immunity and testosterone rapidly respond to acute stress, but is corticosterone at the helm?

When faced with a stressor, vertebrates can rapidly increase the secretion of glucocorticoids, which is thought to improve the chances of survival. Concurrent changes in other physiological systems, such as the reproductive endocrine or innate immune systems, have received less attention, particularly in wild vertebrates. It is often thought that glucocorticoids directly modulate immune performance during a stress response, but, in many species, androgens also rapidly respond to stress. However, to our knowledge, no study has simultaneously examined the interactions between the glucocorticoid, androgen, and innate immune responses to stress in a wild vertebrate. To address this issue, we tested the hypothesis that the change in plasma corticosterone (CORT) in response to the acute stress of capture and restraint is correlated with the concurrent changes in plasma testosterone (T) and innate immune performance (estimated by the capacity of plasma to agglutinate and lyse foreign cells) in the Abert's Towhee (Melozone aberti). Furthermore, to broaden the generality of the findings, we compared male and female towhees, as well as males from urban and non-urban populations. Acute stress increased plasma CORT, decreased plasma T in males, and decreased innate immune performance, but the increase in CORT during stress was not correlated with the corresponding decreases in either plasma T or innate immunity. By contrast, the plasma T stress response was positively correlated with the innate immune stress response. Collectively, our results challenge the proposition that the glucocorticoid stress response is correlated with the concurrent changes in plasma T, a key reproductive hormone, and innate immunity, as estimated by agglutination and lysis.

[Can US-guided vacuum-assisted biopsies be an alternative to diagnostic surgery in cases of non-diagnostic core needle biopsy?]. / Les macrobiopsies echoguidées assistées par le vide peuvent-elles constituer une alternative a la chirurgie diagnostique en cas de microbiopsies non contributives?

PURPOSE: To assess US-guided vacuum-assisted biopsies in the diagnosis of suspicious sonographic breast lesions after non-diagnostic core needle biopsies (CNB). PATIENTS AND METHODS: Retrospective study of 42 females with suspicious breast lesions at US. CNB previously performed were non-diagnostic. Because of the larger sample size, vacuum-assisted biopsies were performed, instead of surgical biopsy. RESULTS: Vacuum-assisted biopsies showed 32 benign lesions. Histologic examination of the CNB showed non-specific fibrous tissue in 43% of cases as opposed to 7.1% for vacuum-assisted biopsies. The latter provided a more specific diagnosis (mainly fibrocystic breast disease). From a total of 4 lesions that were suspicious at CNB, 3 were diagnosed as malignancies after vacuum-assisted biopsy and one case was a "borderline" lesion. Three additional malignant and three additional borderline lesions were diagnosed on vacuum-assisted biopsies. In 11 cases, surgical excision was performed, and all diagnoses from vacuum-assisted biopsies were confirmed at microscopy, except in one case where it was underestimated (ADH versus DCIS). CONCLUSION: US-guided vacuum-assisted biopsy is a reliable technique. Because it provides more tissue than CNB, it can be an alternative to diagnostic surgery after non-diagnostic CNB. Indeed, it allows confirmation of the diagnosis and provides a more specific diagnosis of benign lesions. With regards to malignant and borderline lesions, it avoids the risk of false-negative CNB and overlooking carcinomas.

[Impact on the healthcare team and parents of the type of cardiorespiratory monitoring during phototherapy]. / Impact sur le personnel et les parents du mode de monitorage cardio-respiratoire lors de la photothérapie.

INTRODUCTION: Neonatal jaundice is treated with phototherapy and requires continuous cardiorespiratory monitoring, which can induce parental anxiety. Within a very short time, parents receive the announcement of the diagnosis and of the need for a treatment in another unit with a new team of caregivers. OBJECTIVE: To evaluate parents' anxiety and their feelings concerning the location of treatment concerning cardiorespiratory monitoring equipment (wired vs Wi-Fi wireless monitoring equipment) and treatment location (neonatology vs maternity wards) during a phototherapy treatment in the neonatology unit, located in the maternity wards. METHODS: This was a prospective and monocentric study. Parental anxiety was assessed using the STAI-Y score. Their feelings on the location of treatment were assessed using a specific questionnaire. Three successive periods were considered: period I "wired with neonatology team," period II "Wi-Fi with neonatology team," and period III "Wi-Fi with maternity wards". Comparison between periods I and II evaluated the impact of the monitoring equipment and comparison between periods II and III assessed the impact of the treatment location. RESULTS: No effects of the monitoring equipment were observed. We found an impact of the treatment location in charge of the newborn: the parent's anxiety (STAI-Y score) was lower in the maternity wards, whereas the maternity ward personnel considered the protocol as an increased workload (p<0.001). CONCLUSION: The monitoring equipment had little effect. Parental anxiety decreased when monitoring took place in the usual maternity wards, underscoring the advantages of a close relationship between maternity and neonatology units.

[Skin-to-skin care in the delivery room: impact of SpO2 monitoring]. / Peau-à-peau en salle de naissance : impact du monitorage de la saturation pulsée en oxygène.

BACKGROUND: Skin-to-skin care in the delivery room increases mother-newborn bonding, reduces the newborn's stress level, and facilitates breastfeeding. However, a few reports of life-threatening events in newborn infants during skin-to-skin care have prompted suggestions that SpO2 monitoring may be of value in the delivery room. The present study compared SpO2 monitoring with standard clinical practices during skin-to-skin care in the delivery room. The midwife's opinion and the mother's anxiety level were assessed for both procedures. MATERIALS AND METHODS: The midwife's opinion was measured on a Likert scale and the mother's anxiety level was measured on the State-Trait Anxiety Inventory Y-A and Y-B scales. Two procedures (standard clinical practice vs. SpO2 monitoring) were compared prospectively in two consecutive 3-month periods. RESULTS: Seventy case report forms were completed for the "standard clinical practice" group and 62 were completed for the "SpO2 monitoring" group. The care procedure was considered to be satisfactory or quite satisfactory in 60 cases (96.8%) in the "SpO2 monitoring" group and in 57 cases (81.4%; P<0.05) in the "standard clinical practice" group. There was no significant difference between the groups in terms of the mean maternal anxiety level. CONCLUSION: SpO2 monitoring during skin-to-skin care in the delivery room was well accepted by the midwife. Relative to standard clinical practice alone, SpO2 monitoring was not associated with elevated maternal anxiety levels.

Identification and characterization of a low temperature regulated gene encoding an actin-binding protein from wheat.

A cDNA corresponding to a putative actin-binding protein was cloned from a cold-acclimated wheat cDNA library. The cDNA, designated Wcor719, encodes a polypeptide of 142 amino acids with a calculated molecular mass of 15.8 kDa and a pI of 4.27. The protein has the two conserved domains identified as actin and phosphatidylinositol 4,5-biphosphate (PIP2) binding sites found in members of the cofilin family. Northern analyses revealed that Wcor719 transcript accumulation is rapid and strongly up-regulated by low temperature. This accumulation was greater in the tolerant winter wheat and rye species compared to the less tolerant ones. The rapidity of transcript induction and the significant homology with actin-binding proteins (ABP) from different organisms suggest that the product of this gene might be involved in the dynamic reorganization of the cytoskeleton during low temperature acclimation. It may also serve as a key factor in the signal transduction pathway during cold acclimation.

[Bacteriological diagnosis of tuberculosis: current hieratic classification of methods]. / Diagnostic bactériologique de la tuberculose: hiérarchisation actuelle des méthodes.

To assure the diagnosis of tuberculosis, one needs the observation, the isolation and the identification of the causative agent Mycobacterium tuberculosis. In this approach, the microscopic exam occurs as a fast but neither sensitive or specific test. The isolation on solid media is slow and needs more than three weeks before becoming positive. Nevertheless, it is a sensitive and specific one. The identification of the isolated strain and the study of sensitivity to antibiotic agents require an equal delay. Then, 2 months are necessary to achieve the analysis. The AIDS epidemic with the increase of opportunistic mycobacterial diseases, and the unexpected arrival of resistant Mycobacteria is creating as a difficult therapeutic problem. The cultivation in liquid media with the radiometric method (Bactec) shortens the time of culture by half. The genomic amplification assay has been hopeful because it allowed results in 2 days. However, some technical difficulties happen when the test is conducted and it is less sensitive than the isolation process. The hierarchical classification of the laboratory useful process to establish the diagnosis of tuberculosis disease remains the microscopic observation of the bacilli and their isolation. Today, the use of PCR alone does not assure the diagnosis of tuberculosis, however it may be used as a additional diagnostic test.

[Digestive complications of oral contraceptives: a case of extensive digestive necrosis in a young woman]. / Les accidents digestifs des contraceptifs oraux: un cas de nécrose digestive étendue chez une femme jeune.

PIP: A case of acute intestinal vascular necrosis in a 19-year-old user of oral contraceptives (OCs) is described, and hypotheses explaining the digestive complications of synthetic estrogens are reviewed. The patient had originally presented with a violent gastric pain that subsequently spread to the entire abdomen. An abrupt worsening of her condition involved cardiovascular collapse associated with a peritoneal syndrome, vomiting and dehydration, and hyperleukocytosis. Emergency opening of the peritoneum was followed by evacuation of a large quantity of fetid gas and alimentary debris, and observation of a completely necrosed stomach. A careful lavage of the entire intestinal cavity led to temporary improvement, but it became clear during an attempt at gastrectomy that further treatment would be unavailing and the patient died shortly thereafter. Estrogens were believed to be responsible for the digestive necrosis because it occurred in a young woman who had used an estrogen-rich OC for 3 years and who smoked; a hapatic biopsy confirmed the diagnosis. No traces of other risk factors such as hypertension, hyperlipidemia, diabetes, neoplasia, or obesity were observed. Recent publications indicate that OCs are responsible for a certain number of digestive problems, which may include acceleration of intestinal transit, severe diarrhea, rectorrhagia, ischemic or ulcerative colitis, intestinal infarct which is usually localized, and hepatocellular problems ranging from moderate hepatic insufficiency to malignant tumor and Budd-Chiari syndrome. OCs do not modify hemodynamic regimes, but they may cause elevation of fibrinogen and thrombin, diminution of antithrombin III acitivty, increased platelet adhesivity, and decreased fibrinolysis leading to hypercoagulability. These modifications in hemostasis occur in all OC users and are not statistically correlated with occurence of thrombotic accidents. OCs are probably responsible for parietal vascular lesions; experimental injection of synthetic estrogens is associated with both arterial and venous lesions. The most characteristic anomaly is at the level of the intima, with proliferation of smooth muscle cells and increased conjunctive tissue fibers associated with proliferation of the media or the endothelium. The absence of lipid deposits, the simultaneous appearance of arterial and venous lesions, and other evidence argues against and atheromatous origin of parietal lesions. A significant correlation has been found between high levels of anti-synthetic ethinyl estradiol antibodies and the presence of vascular lesions. It is hypothesized that these circulating immune complexes penetrate the vascular walls of OC users and produce lesions, which may depend on factors such as smoking.^ieng

[Trochanteric fractures in the elderly: Ender nails, prostheses or direct osteosyntheses. Apropos of a continuous series of 265 cases]. / Les fractures de la région trochantérienne du vieillard: clous de Ender, prothèses ou ostéosynthèses directes. A propos d'une série continue de 265 cas.

The results of 265 trochanteric fractures in the elderly treated between 1980 and 1983 have been analysed. Among them, 136 were treated by Ender's nailing, 110 by prostheses and 19 by internal fixation. In an earlier study, Ender's nailing had been used in 75 p. 100 of cases. The conclusions were that the increasing use of a prosthesis has brought about an improvement in the results-80 p. 100 satisfactory in the present series compared with 54 p. 100 in the preceding one. The mortality rate was comparable after Ender's nailing and prostheses. Ender's nailing is indicated in stable fractures and, in unstable fractures, internal fixation is indicated in very active persons, Ender's nailing in non-ambulatory patients and prostheses in elderly patients with sufficient walking ability.

[Maxillary metastasis of malignant thymoma]. / Métastase maxillaire d'un thymome malin.

The authors report a case of maxillary metastasis in the follow up of a malignant thymoma. It seems to be the first case reported in today's scientific literature. The clinical presentation, histopathological features and prognosis of malignant thymoma are discussed. The worse influence of distant metastasis on survival rate is state precisely.

[Closed trauma of the tendon of the brachial triceps. Review of the literature. Apropos of 2 cases]. / Les traumatismes fermés du tendon du triceps brachial. Revue de la littérature. A propos de 2 cas.

Triceps tendon closed trauma remains a rare injury. A palpable gap with impossible elbow extension against gravity is an important physical finding, and a positive "flake sign" or small avulsion fracture from the olecranon is found in the majority of patients. Trans-osseous suture gives excellent results. Partial lesions must be treated conservatively.