[Biological and clinical safety of nomegestrol acetate administered alone then associated in inverse sequence with transdermal 17 beta estradiol, in women at risk of dyslipoproteinemia type IIa]. / Tolérance biologique et clinique du Nomégestrol acétate, administré seul puis associé en séquentiel inversé au 17 beta estradiol cutané, chez des femmes à risque présentant une dyslipoprotéinémie de type IIa.

In this study including 26 patients with dyslipoproteinemia classified IIa, we evaluated biochemical and clinical safety of Nomegestrol acetate (Lutenyl) used for its antigonadotrophin property. It was administered alone, during 3 cycles at the dose of 5 mg/d for 21 days by cycle and then it was associated (at the same sequence and dose), without any wash out, for the next 6 cycles, with a 17 beta estradiol patch (Estraderm TTS 50), 50 micrograms/d from the 11th to the 21st day of each cycle. Nomegestrol acetate, alone, had no significant effect on glycemia, antithrombin III, triglycerides, total cholesterol, apoprotein A1, and LpA1 values compared to those at baseline but apoprotein B and Lp (a) values tended to decrease slightly. Serum progesterone levels were collapsed, and FSH values were low. Weight and blood pressure remained constant. Adding 17 beta estradiol enabled to significantly decrease and normalize the apoprotein B values after the first 3 cycles compared to the baseline values, then these values remained constant during the next 3 cycles. There was no effect on the other parameters (except for a significant increase in plasmatic estradiol values) on the antigonadotrophin property of Nomegestrol acetate, nor on weight and blood pressure which remained constant. Moreover, we observed an important decrease in the rate of amenorrheic cycles compared to those with Nomegestrol acetate alone.

[Comparative evaluation of the acceptability of a new estradiol gel TX11323(A) and a reference gel]. / Evaluation comparative de l'acceptabilité du nouveau gel d'estradiol TX11323(A) et d'un gel de référence.

This randomized, crossed, single-blind study compared the acceptability and drying time of the new estradiol gel TX11323(A) (Estréva Gel, Laboratoire Théramex) to that of a reference gel (CEstrodose, Laboratories Besins-Iscovesco), in two phases. In phase 1, 48 healthy menopausal female volunteers applied 1.5 mg estradiol of each form of estradiol gel on the outer side of the arm for 8 days, with a free period of 7 days between the two treatments. Acceptability, evaluated by self-questionnaire and drying time for the two treatments were noted at day 1 and day 8. The second phase applied only to 16 subjects who followed the same therapeutic protocol, except that this time application was made on the antero-external side of the thighs. Only the subjectively and objectively quantified drying-time was taken into account. A significant difference was found in favor of TX11323(A) gel in terms of the following items: consistency, ease of application and penetration, quantity of gel to apply, sensation of lasting stickness. We note that 68.8% subjects prefer TX11323(A) gel and 27.1% prefer the reference gel (p = 0.001). The timed drying-time for TX11323(A) gel is significantly reduced, 40 to 50% on average depending on the phase, compared to that of the reference gel. The subjective evaluation of the subjects confirms this shorter drying time.

Tears of the triangular fibrocartilage of the wrist: MR imaging.

Magnetic resonance (MR) imaging of the wrist was performed in 35 patients with specific complaints of pain and soft-tissue swelling in the medial side of the wrist. Twenty of the 35 subsequently underwent surgery. In 14 of the patients who underwent surgery, a diagnosis of triangular fibrocartilage (TFC) tear was made at MR imaging; in 13 of the 14 the tear was confirmed by surgical findings. In the six patients with an MR diagnosis of an intact TFC, surgical findings confirmed the diagnosis. These patients were operated on for an abnormality in the vicinity of the TFC (avascular necrosis, ganglion cyst, xanthoma). On the basis of findings from the 20 patients with surgical correlation, the accuracy of MR imaging in the detection of TFC tears was 95%. MR imaging is a valuable noninvasive method in the study of pathologic conditions of the TFC.

Total elbow replacement.

The historic development of prosthetic total elbow arthroplasty is traced and results of constrained, semiconstrained, and nonconstrained designs reported. The authors' personal experience with the semiconstrained total elbow replacement, surgical indications with an emphasis on careful patient selection, and highlights of operative technique are discussed. Pain, instability, ankylosis, and arthritic degeneration of the elbow have inspired many surgical attempts to improve function and relieve pain. The most sophisticated surgical options now include total elbow replacement. This paper reviews the development of total elbow arthroplasty and assesses the experience with semiconstrained total elbow replacements performed at the New York University Medical Center over the last eight years.

Accurate correction in rotational osteotomies.

A method for controlling the degree of rotational correction in rotational osteotomies of long bones is presented. The formula L = 0.017QR has been derived, where Q is the desired angle of correction in degrees, R is the radius of the bone as measured on standard roentgenograms, and L is the distance between marks on the two rotated segments of the surgical specimen. The method is easy, accurate, and reproducible and has been experimentally confirmed on both an acrylic pipe and cadaveric femurs. This technique is useful for controlling rotational correction in osteotomies of all long bones.

A comparison of shoe insole materials in plantar pressure relief.

A clinical study was performed to evaluate the effectiveness of seven shoe insole materials and their ability to relieve areas of high plantar pressure. The following materials were tested: Latex foam, Plastazote, Dynafoam, Ortho felt, PPTR, Spenco, and Molo. Twenty-six patients with areas of high plantar pressure were tested using each of these materials. The Harris and Beath footprinting technique was used to measure plantar pressure. It was found that the average pressure of a clinically painful plantar area was 398.15kN/m2. All insole materials tested decreased this pressure, with averages ranging from 186.33kN/m2 to 286.35kN/m2. PPT, Plastazote and Spenco were the most effective products tested.

AIDS retrovirus antibodies in hemophiliacs treated with factor VIII or factor IX concentrates, cryoprecipitate, or fresh frozen plasma: prevalence, seroconversion rate, and clinical correlations.

Antibodies to the AIDS retrovirus, specifically to human T cell lymphotropic virus, type III, and AIDS-associated retrovirus, were detected with increasing prevalence in a population of 190 hemophiliacs from western Pennsylvania between 1981 and 1984: 7.7% in 1981, 20.0% in 1982, 45.5% in 1983, and 62.5% in 1984. The seropositive included approximately three fourths of those receiving factor VIII concentrate, nearly one third of those receiving factor IX concentrate, nearly one fifth of those receiving cryoprecipitate, and none of those receiving fresh frozen plasma. The seroconversion rate, determined on 43 seropositive hemophiliacs from this group who were serially sampled, was 0% in 1977, 4.7% in 1978, 4.9% in 1979, 2.6% in 1980, 10.5% in 1981, 52.9% in 1982, 87.5% in 1983, and 100% in 1984. Of 27 seropositive for three or more years (since 1982 or before), four (15%) have developed AIDS and seven (26%), diffuse lymphadenopathy (ARC); of 16 seropositive for less than three years, none has developed AIDS and three (19%) have developed ARC. The mean time from seroconversion to onset of ARC, 0.8 +/- 0.2 years (SEM), was shorter (P less than .001) than the time to onset of AIDS, 4.1 +/- 0.6 years. These findings confirm the widespread presence of AIDS retrovirus and support the association of these retroviruses with the acquired immunodeficiency syndrome and related conditions.