[Pre-iliac tumor mass syndrome: An atypical rheumatoid nodule]. / Syndrome de masse tumorale pré-iliaque : un nodule rhumatoïde atypique.

Rheumatoid arthritis (RA) is a polymorphous chronic inflammatory disease that is common in general population and is responsible for the occurrence of subcutaneous or visceral rheumatoid nodules. Their typical clinical presentations and localizations do not generally pose any diagnostic or therapeutic problem. We report here an atypical fistulized presentation of an unusual iliac rheumatoid nodule in a 65-year-old female patient. The evolution was favorable without recurrence at 6 months after complete surgical resection and appropriate antibiotherapy.

Methylmetacrylate (PMMA) cranioplasty technique: Technical interest of intraoperative modeling and review of the literature.

Reconstruction of bone loss in the cranial vault may be necessary for functional or aesthetic reasons following trauma, decompression craniectomy, or craniofacial malformations. Many techniques have been described in the literature, using various materials, each with its own advantages and drawbacks. Reconstruction with polymethylmetacrylate cement has the advantage of a durable result and relative ease of use. In this article we present our cement cranioplasty technique through 4 clinical cases of cranial vault reconstruction, by direct intraoperative modeling on the bone defect. This accessible, effective method, applicable to all sizes of defect, remains an attractive option in the arsenal of techniques available today.

Geometric microcanonical theory of two-dimensional truncated Euler flows.

This paper presents a geometric microcanonical ensemble perspective on two-dimensional truncated Euler flows, which contain a finite number of (Fourier) modes and conserve energy and enstrophy. We explicitly perform phase space volume integrals over shells of constant energy and enstrophy. Two applications are considered. In the first part, we determine the average energy spectrum for highly condensed flow configurations and show that the result is consistent with Kraichnan's canonical ensemble description, despite the fact that no thermodynamic limit is invoked. In the second part, we compute the probability density for the largest-scale mode of a free-slip flow in a square, which displays reversals. We test the results against numerical simulations of a minimal model and find excellent agreement with the microcanonical theory, unlike the canonical theory, which fails to describe the bimodal statistics. This article is part of the theme issue 'Mathematical problems in physical fluid dynamics (part 2)'.

The Galerkin-truncated Burgers equation: crossover from inviscid-thermalized to Kardar-Parisi-Zhang scaling.

The one-dimensional Galerkin-truncated Burgers equation, with both dissipation and noise terms included, is studied using spectral methods. When the truncation-scale Reynolds number [Formula: see text] is varied, from very small values to order 1 values, the scale-dependent correlation time [Formula: see text] is shown to follow the expected crossover from the short-distance [Formula: see text] Edwards-Wilkinson scaling to the universal long-distance Kardar-Parisi-Zhang scaling [Formula: see text]. In the inviscid limit, [Formula: see text], we show that the system displays another crossover to the Galerkin-truncated inviscid-Burgers regime that admits thermalized solutions with [Formula: see text]. The scaling forms of the time-correlation functions are shown to follow the known analytical laws and the skewness and excess kurtosis of the interface increments distributions are characterized. This article is part of the theme issue 'Scaling the turbulence edifice (part 2)'.

Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS).

Lower extremity war wounds are characterized by high-energy trauma occasioning loss of complex and pluritissular substances. The support pipeline put into place by the French defense health service (SSA) is designed to rapidly evacuate the injured person from the scene of injury to mainland France, following initial surgery in the framework of a sequential tactic known as "Damage Control Surgery". This strategy is aimed at stabilizing the traumatized individual and enabling his evacuation. Patients are subsequently treated in a restorative surgery unit in a Hôpital d'Instruction des Armées (HIA), a level 1 trauma center (HIA Percy, HIA Saint-Anne) Cooperation between the plastic and orthopedic surgery specialties is essential insofar as it allows for surgical optimization aimed at saving the limb while restoring function to the greatest possible extent. Notwithstanding painstaking application of this common strategy, septic pseudoarthrosis remains the principal and most feared complication, at times rendering impossible any therapeutic solution other than amputation. Whether prosthetic or non-prosthetic, the rehabilitation provided by doctor/physiotherapists is conducive to patients' social and professional reintegration. The nation's duty to assist its wounded veterans is carried out with determination by the French defense ministry. As concerns lower extremity war wounds, the authors detail the reconstruction doctrine based on the 6/7/8/9 rule, in accordance with which strategies for repair of soft tissue and reconstruction of the lost bone substance have been developed.

[The "racket-like" flap: Method to increase the reliability of the sural neuro-cutaneous flap]. / Le lambeau neurofasciocutané sural : fiabilisation par le prélèvement d'un lambeau en raquette.

We realized a retrospective study from 2003 to 2018 comparing two surgical techniques of neuro-fascio-cutaneous sural flap harvesting to improve their reliability: the "vascular pedicle tunneling" method and the "racket-like" flap method. There are 35 flaps in this series from lower distal limb reconstruction: 21 "racket-like" flaps and 14 "tunneling-pedicle" flaps. There were no partial or total necrosis case in the "racket-like" flaps group. Our technique reduces covering failure due to partial or total necrosis risk with a statistically significant impact. We propose to extend the "racket-like" technique to every fascio-cutaneous flap available.

Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review.

Yttrium-90-Ibritumomab Tiuxetan (Zevalin®) is used in the treatment of non- Hodgkin's lymphoma. Extravasation is an iatrogenic complication that is fortunately rare. However, the treatment of this complication is often complex due to the risk of extensive skin necrosis and unpredictable evolution of localized irradiation. This vesicant drug requires emergency management when extravasation occured. Radiations burns have specificities. Therefore, wound coverage involves specific plastic surgical techniques. Here, we report the case of a man presenting a chronic and extensive skin necrosis of upper arm treated with an antero-lateral thigh free flap. Moreover, we compare our experience of Zevalin® extravasation management to other past publications and propose recommendations to prevent this unacceptable complication.

Grafting both acute wound site and adjacent donor site with the same graft: an easy and safe procedure to improve healing and minimize pain in elderly and bedridden patients.

In harvesting skin to cover the defect caused by a burn, a second wound is created, the donor site wound. We propose an alternative method to manage the donor site: taking a split-thickness skin graft (STSG) from a donor site adjacent to the burn wound to be treated, and meshing at a 3:1 ratio to cover both sites at once. The main objective of this study is to evaluate the effectiveness of covering both burn wound and adjacent donor site with the same STSG in elderly and bedridden patients. We retrospectively reviewed the medical records of 6 patients over 60 years old or/and bedridden presenting with a small burn wound who underwent STSG of both burn wound and adjacent donor site between April 2016 and November 2016 in the Department of Plastic Surgery and Burn Treatment at Percy Military Hospital (France). Their data were compared with data of five patients who had undergone the usual STSG procedure during the same period. There was a statistically significant difference between patients who underwent adjacent STSG procedure and those who underwent usual STSG procedure in healing time (days) mean (SD) (7,33 ± 1,03 vs. 16,2 ± 0,83; p = 0,007) and Numeric Rating Scale pain mean (SD) at day 2 (0,33 ± 0,33 vs. 2,4 ± 1,35; p = 0,04). Grafting both acute burn wound and adjacent donor site with the same graft seems to be an easy method to improve healing and minimize pain in the STSG donor site in elderly and bedridden patients.

Lors du prélèvement de peau mince pour couvrir une plaie causée par une brûlure, une seconde plaie est créée, le site donneur. Voici une méthode alternative pour la gestion du site donneur: prélever une greffe de peau mince GPM à partir d'un site donneur adjacent à la brûlure, l'expandre avec un ratio de 3:1 pour couvrir les deux sites à la fois. Ici l'objectif principal est d'évaluer l'efficacité de la couverture simultanée d'une petite brûlure et du site donneur adjacent avec la même GPM chez les patients âgés et alités. Nous avons étudié rétrospectivement les dossiers de 6 patients traités par couverture simultanée de la brûlure et du site donneur adjacent avec la même GPM entre avril 2016 et novembre 2016 dans le Service de Chirurgie Plastique de l'hôpital militaire Percy (France). Les données ont été comparées à un groupe similaire de patients qui ont subi une procédure habituelle durant la même période. Il y avait une différence statistiquement significative entre les patients qui ont subi une procédure de GPM du site donneur adjacent et ceux qui ont subi une procédure habituelle sur la durée (jours) moyenne (écart-type, SD) de cicatrisation (7,33 ± 1,03 vs 16,2 ± 0,83; p = 0,007) et de la douleur sur l'échelle numérique au jour 2 (0,33 ± 0,33 vs 2,4 ± 1,35; p = 0,04). Greffer la plaie liée à la brûlure aiguë et le site donneur adjacent avec une même GPM semble être une méthode simple pour améliorer la guérison et minimiser la douleur du site donneur.

Effects of replacing corn with sorghum on the performance of overfed mule ducks.

The aim of this trial was to study the effects of replacing yellow corn (C) with condensed tannin-free sorghum (S) during the finishing period (F period; age 53 to 79 d) and/or overfeeding period (O period; age 80 to 91 d) on the performance of overfed mule ducks. 192 ducks were divided into 4 groups (48 in each) differing in the cereal (yellow corn or sorghum) included in the diet given during the F and/or the O periods, using a 2 × 2 factorial arrangement of treatments : SS, SC, CS, CC. At the end of the O period, the birds were slaughtered after 10 h of fasting to measure foie gras and magret qualities. Mortality (1%; P > 0.05) and weight gain (2,030 g; P > 0.05) during the O period were similar in the 4 groups. At the end of the O period, birds overfed with sorghum had foie gras that was heavier (723 vs. 694 g in CS+SS vs. CC+SC, respectively; P < 0.05) and less yellow (24.40 vs. 38.59 for b* in CS+SS vs. CC+SC, respectively; P < 0.001) than birds overfed with corn. Fat loss during foie gras cooking was similar in the 4 groups (18%; P > 0.05), but the foie gras was less yellow in birds overfed with sorghum (14.84 vs. 26.01 for b* in CS+SS vs. CC+SC, respectively; P < 0.001). Weight of magret was similar in the 4 groups (491 g, P > 0.05) but the color of the breast muscle and skin of magret was less yellow in birds overfed with sorghum compared with corn (12.26 vs. 12.92 and 13.84 vs. 18.30 in CS+SS vs. CC+SC, respectively; P < 0.001). In conclusion, the replacement of yellow corn with sorghum during finishing and/or overfeeding is possible and useful in a mule duck foie gras production system because it increases foie gras weight without decreasing the weight of magret However, it changes the quality of the products, mainly their color.

Effect of incorporating sugar beet pulp in the finisher diet on performance of geese.

The aim of this work was to study the effects of incorporating sugar beet pulp (SBP) into the diet on the development of the crop and performance of geese. A total of 480 1-day-old ganders were divided into three groups differing in the composition and mode of distribution of the diet offered from day 56 to 89. The following two diets were used: a standard diet (nitrogen-corrected apparent metabolizable energy, AMEn 11.44 MJ/kg; 160 g/kg CP) or a diet containing 10% of SBP (SBP diet; AMEn 11.47 MJ/kg; 160 g/kg CP). The swelling capacity (SC) hydration was higher for SBP than for the standard diet (3.62 v. 2.72 ml of H2O/g of dry matter at 60 min; P<0.05). In the Control group, birds were fed with a controlled time of access to a standard diet. Other birds were fed the SBP diet with a controlled time of access (SBPt group) or a controlled quantity offered (SBPq). From day 90 to 104, 88 birds/group were overfed with a mixture containing mainly corn. Body traits including volume of the crop were measured at day 89. Fatty liver weight and commercial grading were measured at d 104. Feed intake from day 56 to 89 was higher in the Control group than in the SBPt group (8097 v. 7545 g; P<0.05), feed intake in the SBPq group being intermediate (7801 g); however, live weights (LW) of the birds were similar in the three groups measured at day 89 (5746 g; P>0.05). At day 89, the volume of the crop tended to be higher in the SBPt compared with the Control group (52.8 v. 48.8 ml/kg of LW; P=0.101). After overfeeding, feed intake (12 922 g), weight gain (2412 g), LW (8170 g), fatty liver weight (875 g) and commercial grading of the fatty liver were similar (P>0.1) for all the three groups. Therefore, SBP could help adapt the digestive tract of waterfowl to high feed intake through an increase in the crop volume, but its method of use - that is, level of incorporation and mode of distribution - should continue to be investigated.

Forced magnetohydrodynamic turbulence in three dimensions using Taylor-Green symmetries.

We examine the scaling laws of magnetohydrodynamic (MHD) turbulence for three different types of forcing functions and imposing at all times the fourfold symmetries of the Taylor-Green (TG) vortex generalized to MHD; no uniform magnetic field is present and the magnetic Prandtl number is equal to unity. We also include pumping in the induction equation, and we take the three configurations studied in the decaying case in Lee et al. [Phys. Rev. E 81, 016318 (2010)]. To that effect, we employ direct numerical simulations up to an equivalent resolution of 20483 grid points. We find that, similarly to the case when the forcing is absent, different spectral indices for the total energy spectrum emerge, corresponding to either a Kolmogorov law, an Iroshnikov-Kraichnan law that arises from the interactions of turbulent eddies and Alfvén waves, or to weak turbulence when the large-scale magnetic field is strong. We also examine the inertial range dynamics in terms of the ratios of kinetic to magnetic energy, and of the turnover time to the Alfvén time, and analyze the temporal variations of these quasiequilibria.

Ideal evolution of magnetohydrodynamic turbulence when imposing Taylor-Green symmetries.

We investigate the ideal and incompressible magnetohydrodynamic (MHD) equations in three space dimensions for the development of potentially singular structures. The methodology consists in implementing the fourfold symmetries of the Taylor-Green vortex generalized to MHD, leading to substantial computer time and memory savings at a given resolution; we also use a regridding method that allows for lower-resolution runs at early times, with no loss of spectral accuracy. One magnetic configuration is examined at an equivalent resolution of 6144(3) points and three different configurations on grids of 4096(3) points. At the highest resolution, two different current and vorticity sheet systems are found to collide, producing two successive accelerations in the development of small scales. At the latest time, a convergence of magnetic field lines to the location of maximum current is probably leading locally to a strong bending and directional variability of such lines. A novel analytical method, based on sharp analysis inequalities, is used to assess the validity of the finite-time singularity scenario. This method allows one to rule out spurious singularities by evaluating the rate at which the logarithmic decrement of the analyticity-strip method goes to zero. The result is that the finite-time singularity scenario cannot be ruled out, and the singularity time could be somewhere between t=2.33 and t=2.70. More robust conclusions will require higher resolution runs and grid-point interpolation measurements of maximum current and vorticity.

[Surgical strategy for neck burns and their sequelae]. / Stratégie chirurgicale des brûlures du cou et de leurs séquelles.

Burns of the neck are common and expose them to functional and aesthetic complications which are sometimes very serious. Care in the acute stage and treatment of sequelae contribute to a common goal of restoration: Maintain or recreate a chin-neck angle and get a quality skin as close as possible to the original skin, in terms of flexibility, texture, thickness and color. The wide variety of cases encountered requires knowing the armamentarium available to us today, and the anatomical basis and clinical underlying indications.

[Radiation burn "innovating therapeutic approach"]. / Brûlure par irradiation « approche thérapeutique innovante ¼.

Radiation burn is a determinist effect of localized irradiation. The lesion is in good correlation with absorbed dose. Radiation burn is different from thermal burn. The evolution is spatiotemporal unpredictable with successive inflammatory waves and recurrence of necrosis. The conventional surgical treatment is rarely efficient because each surgical operative act seems to stimulate the inflammatory waves and fibro-necrosis process. The lesion can escape to this conventional surgical treatment. The new therapeutic approach combines surgery and cellular therapy with local administration of autologous mesenchymal stem cells. From 5 years, cell therapy have been an adjuvant treatment of surgery. This association is a therapeutic innovation, it's now the recommendation for conservative surgery of this very serious radiation burn.

Lack of universality in decaying magnetohydrodynamic turbulence.

Using computations of three-dimensional magnetohydrodynamic (MHD) turbulence with a Taylor-Green flow, whose inherent time-independent symmetries are implemented numerically, and in the absence of either a forcing function or an imposed uniform magnetic field, we show that three different inertial ranges for the energy spectrum may emerge for three different initial magnetic fields, the selecting parameter being the ratio of nonlinear eddy to Alfvén time. Equivalent computational grids range from 128(3) to 2048(3) points with a unit magnetic Prandtl number and a Taylor Reynolds number of up to 1500 at the peak of dissipation. We also show a convergence of our results with Reynolds number. Our study is consistent with previous findings of a variety of energy spectra in MHD turbulence by studies performed in the presence of both a forcing term with a given correlation time and a strong, uniform magnetic field. However, in contrast to the previous studies, here the ratio of characteristic time scales can only be ascribed to the intrinsic nonlinear dynamics of the paradigmatic flows under study.

Cascades, thermalization, and eddy viscosity in helical Galerkin truncated Euler flows.

The dynamics of the truncated Euler equations with helical initial conditions are studied. Transient energy and helicity cascades leading to Kraichnan helical absolute equilibrium at small scales, including a linear scaling of the relative helicity spectrum are obtained. Strong helicity effects are found using initial data concentrated at high wave numbers. Using low-wave-number initial conditions, the results of Cichowlas et.al. [Phys. Rev. Lett. 95, 264502 (2005)] are extended to helical flows. Similarities between the turbulent transient evolution of the ideal (time-reversible) system and viscous helical flows are found. Using an argument in the manner of Frisch et. al. [Phys. Rev. Lett. 101, 144501 (2008)], the excess of relative helicity found at small scales in the viscous run is related to the thermalization of the ideal flow. The observed differences in the behavior of truncated Euler and (constant viscosity) Navier-Stokes are qualitatively understood using the concept of eddy viscosity. The large scales of truncated Euler equations are then shown to follow quantitatively an effective Navier-Stokes dynamics based on a variable (scale dependent) eddy viscosity.

Paradigmatic flow for small-scale magnetohydrodynamics: properties of the ideal case and the collision of current sheets.

We propose two sets of initial conditions for magnetohydrodynamics (MHD) in which both the velocity and the magnetic fields have spatial symmetries that are preserved by the dynamical equations as the system evolves. When implemented numerically they allow for substantial savings in CPU time and memory storage requirements for a given resolved scale separation. Basic properties of these Taylor-Green flows generalized to MHD are given, and the ideal nondissipative case is studied up to the equivalent of 2048;{3} grid points for one of these flows. The temporal evolution of the logarithmic decrements delta of the energy spectrum remains exponential at the highest spatial resolution considered, for which an acceleration is observed briefly before the grid resolution is reached. Up to the end of the exponential decay of delta , the behavior is consistent with a regular flow with no appearance of a singularity. The subsequent short acceleration in the formation of small magnetic scales can be associated with a near collision of two current sheets driven together by magnetic pressure. It leads to strong gradients with a fast rotation of the direction of the magnetic field, a feature also observed in the solar wind.

[Microsurgery: History of instrumental vascular anastomoses, our experience with eversion-stapling using VCS forceps]. / Microchirurgie: passé, présent, futur... Histoire des anastomoses vasculaires instrumentales, expérience personnelle par éversion et agrafage par pince VCS.

One century, after Carrel in 1906, technics of vascular surgery are the same. After two world wars, peace surgery has been improved by war surgery. Microscopy surgery gave a new way for vascular surgery which became microsurgery with specific instrumentation. We have move from the developing period of microsurgery in the 1970s, to the fully matured period of microsurgery in the 1980s and the the development of clinical free flaps. The 1990s must be the turning point from autogenous tissue transplantation to allogenic transplantation. Ethic comity keeps keys of future! About microvascular anastomoses, many instrumental technics are explored but no-one is better than the classic manual suture. For us, the best instrumental technic is the anastomose with titanium clips VCS((R)) but we only use it in good situation without difficulties.