[Franche Comté hospitals between conquest and revolution. Apogee and architectural refinement]. / L'hôpital comtois entre conquête et révolution. Apogée et raffinement architectural.

In the architecture of hospitals, Franche Comté has a particular part: sumptuous 'baroque' structures from the XVIo and XVIIo centuries are specifically captivating by some historical, political, geographical and human reasons.

[The hospital law of December 21, 1941: origins, consequences]. / La loi hospitalière du 21 dècembre 1941: origines, conséquences.

The first law about the organization of the French hospitals dates back to 1796 with the French Revolution which asserts the powerful administrative commission, chaired by the mayor of each town. In 1941, the new law created the job of director whose task was to apply the decisions of the commission. In the same time, the hospital practice was no longer free and the practitioners were chosen by medical boards of examiners. During the following 60 years, the commission lost its power at the advantage of the director whose authority increased at the expense of the medical autonomy. Therefore the economic necessity lead the government to keep a close eye on the operating budget of the hospitals but the search of the budgetary balance means new strategic developments for the future.

[Air cleanliness in operating rooms: on-site controls and biological testing]. / La maîtrise de la propreté de l'air des locaux opératoires: intérêt des mesures en activité et des examens microbiologiques.

Air cleanliness control in operating rooms is based on air filtration, and targets the lowest density of particules and bacteria. Legally, the equipment must be periodically verified during periods of inactivity. Most airborne bacteria are of human origin. There is no fixed ratio between the particle count and the level of bacterial contamination. A study of different types of operating room at Besançon Medical Center reached the following conclusions:--Controls are also required during periods of activity.--Bacteriological testing is crucial.--Unidirectional airflow, especially of the horizontal type, is superior to other forms of isolation. The authors propose a "Functionality index", calculated as follows: bacterial count during use of the room minus bacterial count during non use/the number of people in the room. Efficient equipment would have a low index, which would be unmodified by the number of persons present.

[Articular reconstructions by a costochondral grafting (or osteochondral costal grafting)]. / Utilisation du greffon cartilagineux (ou ostéocartilagineux) costal en reconstruction articulaire.

We describe a novel technique of costochondral autografting for the treatment of trapeziometacarpal arthritis, radioscaphoid osteoarthritis, malunion of the distal end of the radius, and osteoarticular loss of the MP joints of long fingers. The costal graft harvest technique is always the same. A 5-cm horizontal incision is made over the 9th rib, and the rib is exposed at the osteocartilaginous junction. Cartilaginous grafts are harvested with a scalpel, and osteocartilaginous grafts with a saw. Since 1992, 116 patients with trapezio-metacarpal arthritis have been treated by partial trapeziectomy and autologous rib cartilage grafting. One hundred patients were reviewed with an average follow-up of 5.6 years. The results were better than those of trapeziectomy with tendon interposition or ligamentous reconstruction, owing to good stability of the thumb ray height. For the treatment of radioscaphoid osteoarthritis following scaphoid non union or chronic scapholunate instability, partial carpal arthrodesis and resection of the first row are the classical techniques. As an alternative to these procedures, 18 patients were treated by resection of the proximal portion of the scaphoid and insertion of an osteochondral costal autograft. Mean follow-up is 4.1 years. The results are excellent or good in 15 cases, fair in 2 cases, and poor in 1 case (luxation of the graft). Four patients with articular malunion of the distal radius received an osteocartilaginous costal graft to reconstruct the articular surface of the radius while avoiding partial or total arthrodesis of the wrist. Four patients with segmental osteoarticular loss of the longfingers were treated with the same technique, thereby avoiding silicone arthroplasty. We review the literature on cartilaginous rib grafts in maxillofajcial and orthopaedic surgery. In our experience, MRI and biopsy show viable cartilage but also histologic changes such as revascularization, fibrous transformation and bone metaplasia.

[The centralization of medical studies in universities under Napoleon I. History and consequences]. / La centralisation universitaire napoléonienne en médecine. Histoire et conséquences.

The so called "Loi du 19 ventose au XI" is two centuries old. It is a very important text of the French universitary story. It stands out the end of the Revolution in the medical studies. It enjoyed the most part of the contemporary people. But other arrangements of the law are more debatable. Thus, medical and surgical unity was already acquired before French Revolution. Furthermore, the absence of surgical practical training was a serious gap. At last, universitary Centralisation, which contrasts, with previous Decentralisation and the historical evolution of many countries, is an option with later pejorative consequences. Il was necessary to remind the events which consolidated centralisation (creation of School of medicine without autonomy in 1820, 1958 ordonnances, 1968 Revolution and after 1981, "internat national", "internat qualifiant", Lastly, the creation of C-NRS and INSERM took the leadership of research from University. Of course, other events hindered centralisation (Epic of "Internat des hôpitaux", 1871-1878 crisis, and 1910 campaign against agregation). But today, the faculties of Medicine have no real autonomy. The consequences are the standardization of the studies, the absence of competition and a poor overall result. The components of this result are not peculiar to centralisation. But this one prevents any reform. Is this logical reform really whished by the French people?

[The importance of isolating septic patients in an autonomous unit in orthopedic surgery and traumatology]. / L'intérêt de l'isolement en secteur autonome des patients septiques, en chirurgie orthopédique et traumatologique.

UNLABELLED: To examine whether Sepsis Containment Units are presently in use by French Orthopedic surgeons in a number of hospitals and the subsequent efficacy of these measures in the prevention of risks linked to methicillin resistant Staphylococcus aureus (MRSA), MRSA was used as an example because it is the bacteria most frequently associated with infection in orthopedics. The transient carriage of MRSA on the hands of hospital personnel is the most common mechanism of patient to patient transmission. Consequently, the incidence of nosocomial MRSA in patients can be used to assess the quality of infection control. SETTING: The orthopaedic surgery department (104 beds) of a 1. 228 bed, university affiliated public hospital located in eastern France (Besançon). METHODS: First: a questionnaire was sent out to 71 French university orthopedic departments to investigate the practice in place. Second: to establish whether a significant correlation exists between the colonisation pressure exerted by real imported MRSA, and the number of cases of real acquired MRSA since we know that colonisation pressure of bacteria is a major factor in the prognosis of clinical infection. Third: our orthopedic surgery department was redesigned to study the risks of colonisation pressure with or without Sepsis Containment Units. RESULTS: First: among the 71 orthopedic departments studied, only 11 used a Sepsis Containment Unit. Second: there is a definite, linear relationship between the colonisation pressure exerted in a unit by real imported MRSA and the number of cases of real acquired clinical infection. Third: in the absence of Sepsis Containment Units, the risk of MRSA infections is increased by 160%. Debat: the classical clinical arguments concerning the dangers of hand or aerobic MRSA transmission are confirmed by our figures. The strict use of Sepsis Containment Units prevents contamination of septics by septics. Inversely, the rigorous concentration of means in the Sepsis Containment Units also prevents cross contamination of septics. At question are the psychological and financial inconveniences of Sepsis Containment Units. The results of this experiment, performed in orthopedic surgery, show that the use of Sepsis Containment Units is just as critical in other surgical units: vascular, thoracic, etc., nor should they be overlooked in outpatient and emergency care--often the first step in orthopedic surgery. CONCLUSION: Sepsis Containment Units are essential and merit further development.