Management of neglected post-traumatic ipsilateral distal femoral and proximal tibial epiphysiodeses in adolescent: Case report.

Introduction: It is important to remember the risk of post-traumatic epiphysiodesis in the context of high-speed impacts around the knee. This clinical case illustrates the risk of lower limb length discrepancy resulting from this, the treatment and management thereof. This case is unique in that it presents two ipsilateral distal femoral and proximal tibial epiphysiodeses, with secondary inequality of these two bone segments. Case presentation: A 13-year-old adolescent is managed for a displaced diaphyseal fracture of the distal femur. He undergoes surgery for this fracture. He suffered high velocity trauma and is also likely to have suffered Salter V trauma to his distal femoral and proximal tibial ipsilateral physes. The consequence is an unequal length of the tibias and femurs. A femoral lengthening is performed and allows to restore a symmetry of the femurs. The asymmetry of the tibias is neglected, and a residual asymmetry persists and will be corrected later. Discussion: The important elements on the management of high-speed trauma around the knee are recalled. A good assessment of bone growth is necessary and individualized treatment should be chosen. This case is particularly interesting because of the nature of the injuries, their consequences and their treatment. Unfortunately, neglecting the suspicion of physes injuries (especially in proximal tibial) is to be noted.

[Influence of age, growth potential and functionality in the management of bone tumours in children : example of the rotationplasty]. / Cas clinique. Influence de l'âge, du potentiel de croissance et de la fonctionnalité dans la prise en charge des tumeurs osseuses de l'enfant : exemple de la plastie de rotation.

Malignant bone tumours in children are rare diseases whose survival rate has progressively improved in recent years thanks to advances in pharmacology, surgery and radiotherapy. We present the particular case of a very young child with Ewing's sarcoma of the thigh. We discuss the influence of this young age on short and long term care. Limb skeletal immaturity and the residual growth potential need to be integrated to define the safest oncological and functional strategy. For this purpose, we summarize the different possible reconstructive options. We describe the Van Nes rotationplasty that was proposed in our patient's case and we will detail the issues in terms of functional well-being and self-image.

Les tumeurs malignes osseuses de l'enfant sont des pathologies rares dont la survie s'est progressivement améliorée au cours des dernières années grâce aux progrès médicamenteux, chirurgicaux et radiothérapeutiques. Nous présentons le cas particulier d'une très jeune enfant atteinte d'un sarcome d'Ewing de la cuisse. Nous discutons de l'influence de ce jeune âge sur la prise en charge à court et à long termes. L'immaturité squelettique et le potentiel de croissance résiduelle des membres doivent être intégrés pour définir l'attitude la plus sûre sur le plan oncologique et la plus fonctionnelle. à cette fin, nous résumons les différentes options reconstructives possibles. Nous décrivons la plastie de rotation de Van Nes qui a été proposée à notre patiente et nous détaillerons les enjeux relatifs au bien-être fonctionnel et à l'image de soi.

Alkyl-polyacrylate esters are strong mucosal adjuvants.

Synthetic polymers were examined for their potency to enhance mucosal immune responses to inactivated antigens. Aqueous solutions of polyacrylic acid with a MW of 450 kDa (p[AA]) or an butyl-ester thereof with 16% esterification (Butyl16-p[AA]) plus antigen were administered twice intranasally in mice with a 2 week interval. The frequency of IgA-antibody secreting cells (ASCs) in lung cell suspensions was determined 1 week after the second immunisation. Both polymers significantly enhanced the IgA response against inactivated Newcastle disease virus (iNDV), inactivated influenza virus strain MRC-11 (iMRC-11), haemagglutinin/neuraminidase subunits of influenza virus strain A/Texas (HA/NA) and bovine serum albumin (BSA). Butyl16-p(AA) was significantly more effective than non-derivatised p(AA), cholera toxin B subunit (CTB) or liposomes. The factor of increase in IgA-ASCs varied from <10- to >100-fold and depended on the type of antigen, the dose of antigen and the adjuvant. Extremely high responses of about 10,000 IgA-ASCs per million lung cells were detected after immunisation with 5 microg HA/NA plus 50 microg Butyl16-p(AA). Intranasal immunisation with Butyl16-p(AA) resulted in high IgA responses, not only in the lungs, but also in the spleen and in high IgG responses in these organs. We concluded that alkyl-esters of polyacrylate are an interesting, novel category of mucosal adjuvants.

Sulfolipo-cyclodextrin in squalane-in-water as a novel and safe vaccine adjuvant.

Previously, we described synergistic adjuvanticity of combinations of synthetic sulfolipo(SL)-derivatives of polysaccharide (SL-polysaccharides) and squalane-in-water emulsions (squalane/W). In this paper, effects of type of polysaccharide and nature of oil on adjuvanticity, reactogenicity and stability are described. SL-derivatives of the following polysaccharides were synthesised: synthetic polysucroses with weight-average molecular weight (MW) of 400,000 (Ficoll400), 70,000 (Ficoll70) and 39,000 Da (Ficoll39), polyfructose of 5,000 Da (inulin), linear polyglucose of 1,200 Da (maltodextrin) and cyclic polyglucose of 1,135 Da (beta-cyclodextrin). The number of sulphate groups per monosaccharide of the different SL-polysaccharides varied between 0.15 and 0.23 and the number of lipid groups per monosaccharide between 1.15 and 1.29. Adjuvant formulations were prepared by incorporating these SL-polysaccharides into oil-in-water emulsions of either squalane, hexadecane, soya oil or mineral oil. Adjuvanticity of the formulations obtained for humoral responses to inactivated pseudorabies virus (PRV) and inactivated influenza virus strains A/Swine (A/Swine) and MRC-11 (MRC-11) in pigs and MRC-11 and ovalbumin (OVA) in mice depended on the type of oil (squalane = mineral oil > hexadecane = soya oil) but not on the type of polysaccharide backbone of the SL-derivative. Reactogenicity assessed by local swelling in mice decreased with decreasing MW (SL-Ficoll400 = Ficoll70 = Ficoll39 > SL-inulin = SL-maltodextrin > SL-cyclodextrin) when combined with squalane and decreased with the type of oil in the following order: squalane > mineral oil > hexadecane > soya oil when combined with SL-Ficoll400. Stability of the SL-polysaccharide/squalane/W emulsions at elevated temperature increased with decreasing MW of the SL-polysaccharide (SL-Ficoll400 < SL-Ficoll70 = SL-Ficoll39 < SL-inulin = SL-maltodextrin = SL-cyclodextrin). SL-cyclodextrin/squalane/W remained stable for > 2.5 years at 4 degrees C, > 18 weeks at 37 degrees C and > 10 days at 60 degrees C. We concluded that reactogenicity and stability but not adjuvanticity of SL-polysaccharide/squalane/W formulations depended on the MW of SL-polysaccharide and that SL-cyclodextrin/squalane/W is a promising non-mineral oil adjuvant as it combines strong adjuvanticity (i.e. better than the mineral oil-based adjuvant presently applied) with low reactogenicity and good stability.

Effect of various adjuvants on secondary immune response in chickens.

Stimulatory effects of several types of adjuvants on secondary antibody response to inactivated Newcastle disease virus (iNDV) were examined in chickens. For this purpose, animals were primed with iNDV without adjuvant resulting in a low but significant antibody response, boosted with iNDV plus adjuvant 3 weeks later, and analysed for specific antibody titres in serum 3 weeks after the booster. Water-in-mineral oil emulsion (W/O) caused significant increase in antibody titres measured in an indirect enzyme-linked immunosorbent (ELISA), haemagglutination inhibition (HI), and virus neutralisation (VN) assay. The adjuvants tested included three oil-in-water emulsions (i.e. mineral oil-in-water, sulpholipo(SL)-Ficoll400/squalane-in-water and sulpholipo-cyclodextrin/squalane-in-water), three negatively-charged polymers with high molecular weight (i.e. polyacrylate, polystyrenesulphonate and sulpho(S)-Ficoll400) and two surface-active agents (i.e. dimethyldioctadecylammonium bromide (DDA) and Quil A). These adjuvants enhanced significantly the secondary immune response but none reached the titre obtained with W/O. Combinations of adjuvants with distinct physicochemical properties, i.e. polyacrylate and DDA revealed only slight, beneficial effects. We concluded that the various types of adjuvants tested can stimulate secondary immune responses in primed animals but that W/O is superior.

Analysis of oral uptake of a synthetic adjuvant by an immunoassay with monoclonal antibodies.

A blocking ELISA with specific antibodies against a synthetic sulpholipo-polysucrose (SL-Ficoll400) was developed to quantify this vaccine adjuvant component in faeces with the purpose of estimating the uptake thereof by the gastrointestinal tract after oral administration. Specific monoclonal antibodies (MABs) prepared against SL-Ficoll400 did not cross-react with components in murine faeces. SL-Ficoll400 inhibited the reactivity of the MABs in a dose-dependent fashion in the blocking ELISA and the concentration causing 50% inhibition (IC50) was about 1 microg SL-Ficoll400 per milliliter. Derivatives of Ficoll400 lacking sulphate or lipid groups or both were unable to block the MABs (IC50 > 1000 microg/ml) which confirmed the specificity of the test system. Quantification of SL-Ficoll400 in extracts of faeces of untreated mice spiked with SL-Ficoll400 revealed that more than 90% could be recovered. The blocking ELISA was used to quantify SL-Ficoll400 in the faeces of mice given this compound orally. One, two and three days after oral administration, the cumulative recovery of SL-Ficoll400 in faeces was 30, 40 and 92%, respectively. From these data, we concluded that the MABs obtained were specific for SL-Ficoll400, that SL-Ficoll400 in murine faeces could be quantified by a blocking ELISA with MABs and that SL-Ficoll400 was poorly absorbed by the gastrointestinal tract.

Quantitative analysis of a synthetic adjuvant by an immunoassay.

Antibodies against a sulpholipo-derivative of synthetic polysucrose (SL-Ficoll) were prepared with the purpose of developing a detection system for this adjuvant component. SL-Ficolls with polysucrose backbones of 400 kDa (SL-Ficoll400) or 22 kDa (SL-Ficoll22) were not immunogenic. However, SL-Ficoll22 conjugated to bovine serum albumin (SL-Ficoll22-BSA) induced high levels of specific antibodies against SL-Ficoll in mice as determined by an indirect ELISA with either SL-Ficoll400 or SL-Ficoll22 as coating antigen. The specificity of the antibodies was analysed further in a blocking ELISA with SL-Ficoll400 as coat. Dose-dependent inhibition of the ELISA titre was obtained with SL-Ficoll22 and SL-Ficoll400 and the concentration causing 50% inhibition (IC50) was < 1 microg/ml. Non-derivatised polysucrose (Ficoll400) and compounds lacking either lipid or sulphate were not recognised (IC50 > 1000 microg/ml). The reaction of SL-Ficoll400-derivatives with antibodies increased with increasing sulphate and lipid content and maximal inhibition was produced by compounds with a composition similar to the SL-Ficoll22 used for immunisation. Quantitative analysis of SL-Ficoll400 in adjuvant formulations comprising SL-Ficoll400 incorporated in a squalane-in-water emulsion revealed high recovery and sufficient precision. From these data, we conclude that specific antibodies are generated against the synthetic SL-Ficoll400 and that this component of a novel adjuvant formulation can be quantified by an immunoassay.

Alkyl-esters of polyacrylic acid as vaccine adjuvants.

Previously, we demonstrated that polyacrylic acid (PAA) augmented significantly the immune response to inactivated Newcastle disease virus (iNDV) in chickens, but that efficacy was insufficient to replace the water-in-mineral oil (W/O) adjuvant applied for boosting primed animals. Attempting to improve its adjuvanticity, PAA with weight-average molecular weight (Mw) of 450 kDa was grafted with alkyl-chains by esterifying the carboxylic groups with octanol and butanol. The butyl-PAA and octyl-PAA esters obtained varied in degree of esterification between 10% and 92%. Adjuvant activity of water-soluble esters for humoral responses to iNDV was examined in chickens primed previously with iNDV without adjuvant. The alkyl-PAA esters exhibited significantly higher responses than unmodified PAA and titres increased with increasing dose of adjuvant. At doses of 2 mg per animal, octyl- and butyl-PAA esters with a substitution rate of 16% (octyl16-PAA and butyl16-PAA, respectively) gave similar titres as W/O. In aged animals primed with live NDV at early age, butyl16-PAA and W/O elicited comparable antibody responses. Butyl16-PAA was also more effective than PAA in stimulating primary immune responses in mice which was accompanied by stronger local reaction determined by monitoring swelling at the site of injection. Reactogenicity of butyl16-PAA was less than of W/O. We concluded that alkyl-PAA esters are strong adjuvants for primary and secondary responses and that they are promising alternatives to the mineral oil-based adjuvants presently used in various veterinary vaccines.

Sciatic nerve regeneration through venous or nervous grafts in the rat.

This study analyses the interest of isologous venous grafts filled with saline or with Schwann cells versus nerve grafts as guides for regeneration of the sciatic nerve in 35 Wistar rats. Electrophysiological parameters (conduction velocities and distal latencies of motor responses) and the functional index of De Medinacelli were measured several times from 1 month to 1 year after surgery. An histological analysis was performed on 2 control rats and on 3 rats killed 6 or 12 months after surgery: the total number of fibers was counted on a montage photoprint of the whole nerve, and the diameters of axons and the thickness of the myelin sheath were measured on digitized images. With a portion of nerve as guide, the regeneration is faster than with a vein. However, regeneration after 6 months is at least as good with a venous graft filled with Schwann cells, as assessed by electrophysiological, functional, and histological analysis. The addition of Schwann cells in grafted veins allows the nerve to regenerate through longer gaps than previously described (25 vs 15 mm). In order to assess the quality of nerve regeneration, functional, electrophysiological, and histological analysis are complementary.

Millions of children stricken by AIDS.

PIP: Acquired immunodeficiency syndrome (AIDS), besides infecting them with human immunodeficiency virus (HIV), makes children orphans. Unless a grandparent can care for them, children become the heads of families, or the families are scattered. In Uganda, one grandmother cared for her 20 grandchildren whose parents (all 9 of her children and their spouses) had died. 120,000 children in one diocese of Uganda are AIDS orphans. As the number rises, the street becomes the only answer. In Sao Paulo, Brazil, 9% of 8000 street children were seropositive in 1990. More than 1 million children are infected at birth, and others receive contaminated blood transfusions. The ICCB, in collaboration with Caritas Internationalis and CAFOD, has prepared a double issue of Children Worldwide that describes initiatives which are designed to alleviate and prevent the suffering of children due to AIDS.^ieng

Non-toxic antiseptic irrigation with chlorhexidine in experimental revascularization in the rat.

The effect of different wound irrigation fluids upon femoral arteries and veins was investigated in the rat, using microsurgical techniques. Toxicity was evaluated by microscopical observation after selective staining of histological slides. Povidone-iodine, 10%, proved to be a very irritant solution, provoking an attack on the vascular endothelium and secondary thrombosis. Chlorhexidine at 0.05%, 0.02% and 0.001% was found by contrast to have a very low toxicity which was comparable to physiological saline. Experimental investigation of antiseptic solutions should not only include the determination of the antibacterial effect, but also the potential for cell toxicity, using an irrigation technique.

[Osteoid osteoma of the distal end of the radius. Review of the literature in light of a case]. / L'ostéome ostéoïde de l'extrémité distale du radius. Revue de la littérature à la lumière d'un cas.

A case of osteoid osteoma in the distal extremity of the radius is reported. Clinical examination, treatment and clinical course are described and previous publications are reviewed.

Carpal tunnel syndrome in childhood: report of five new cases.

Carpal tunnel syndrome is a condition rarely encountered during the growth period. We describe five new cases in two large Belgian university hospitals. One case concerned a 2-year-old child suffering from disseminated angiomatosis, an association not previously reported. Another case of mild severity corresponded to the classic association of trigger fingers and carpal tunnel syndrome. The third case was posttraumatic, and the last two cases were of the familial type that previously has been reported in four families. We discuss these observations and briefly review the literature.

[Current treatment of fresh lesions of the flexor tendons]. / Traitement actuel des lésions fraîches des tendons fléchisseurs.

Different aspects of primary treatment of flexor tendon lesions are reviewed. Of outstanding importance are: adequate setting and instruments plus meticulous repair with fine material, avoidance of traumatic manipulation of structures and anatomical repair, use of dynamic mobilisation of reconstructed tendons within a team of well informed and motivated therapists.

[Current emergency treatment of lesions of the flexor tendons: anatomical, biomechanical and cicatricial aspects]. / Traitement actuel des lésions des tendons fléchisseurs en urgence: les notions anatomiques, biomécaniques et cicatricielles.

Emergency treatment of flexor tendon lesion in 1988: anatomic biomechanical and healing characteristics. Flexor tendon surgery in 1988 must take into account detailed anatomic knowledge as well as healing and biomechanical properties of flexor tendons. Application of standardised surgical technics allows reliable treatment when the surgeon is familiar with these technics and the basic knowledge they suppose. The authors detail the technics and certain details with practical goals.

[Current trends in experimental peripheral nerve regeneration]. / Nouvelles orientations en régénération nerveuse périphérique expérimentale.

Large posttraumatic defects in the peripheral nervous system need to discover methods to solve the demand of nerve grafts. There is no definite answer now. The authors present a model for nervous regeneration studies. Experiments are performed in the Wistar rat. A venous isograft is used to bridge defects of various size in a divided rat sciatic nerve. The venous tube is a guide for axonal regeneration. In one series, the tube is filled with physiological saline and, in a second one, neonatal Schwann cells are injected in the venous isograft. Results recorded are a combination of quantitative methods: neurophysiology and morphometry. The injection of neonatal Schwann cells is able to stimulate nerve regeneration but not completely.