Electrical stimulation for epilepsy: stimulation of hippocampal foci.

Subacute and chronic continuous electrical stimulation at the epileptic focus in the hippocampus or parahippocampal cortex at 130 Hz, 0.21-1.0 ms, 2.5-3.5 V (about 200-300 microA) induces a decrease in focal EEG epileptic interictal activity and also in the occurrence of clinical seizures. This may represent an alternative for the treatment of temporal lobe seizures originated in bilateral independent temporal lobe foci or occurring in patients where one is uncertain whether memory deficit might result from ablative procedures.

[RU 486 and sulprostone in pregnancy termination in the 2nd and 3rd trimesters]. / RU 486 et sulprostone dans le cadre des interruptions médicales de la grossesse aux 2e et 3e trimestres.

OBJECTIVE: Describe our experience with the RU 486 (mifepristone) in case of pregnancy termination induced by sulprostone. METHOD: Prospective non controlled study in the department of Fetal Medicine of the "Institut de Puériculture de Paris". 158 women undergoing termination of pregnancy during the second and third trimester received a single dose of 600 mg of RU 486, 36 hours prior to infusion of 100 micrograms/hour of sulprostone. MAIN OUTCOME MEASURES: Delay between sulprostone therapy and diagnosis of labour duration of delivery. Prostaglandin doses used and frequency of secondary effects. RESULTS: The mean time between sulprostone administration and diagnosis of labour (146.5 +/- 106 minutes) as well delay of delivery (592.2 +/- 504 minutes) corresponded to the results reported in the literature. The primigravid women needed higher doses of prostaglandin and consequently experienced more secondary effects. No severe secondary effects were observed in this study. CONCLUSION: RU 486 is a satisfactory treatment for pregnancy termination during the second or third trimester.

[Glomus tumor of the sciatic nerve]. / Tumeur glomique du nerf sciatique.

Nervous glomus tumor is an exceptional lesion, as only one case has been reported in the literature. A case of sciatic nerve glomus tumor is described. Because of the intra-neural location of the tumor with complete loss of the fascicular structures, the tibial nerve was resected and grafted. Light microscopy clearly demonstrated a glomus tumor; the histological features of these cells are typical of this lesion.

Closed traumatic rupture of the ring finger flexor tendon pulley.

We report an unusual case of closed traumatic rupture of the ring finger flexor tendon pulley not previously reported in the literature. This injury occurred in a 21-year-old athlete during rockclimbing. Lack of flexion of the distal interphalangeal joint was accompanied by a palpable subcutaneous cord on the palmar side of the proximal phalanx. A simple repair of the pulley was done. The postoperative functional result was satisfactory.

[Chronic instability of the metacarpophalangeal joint of the thumb without arthrosis. Apropos of 16 cases]. / Instabilité chronique de l'articulation métacarpo-phalangienne du pouce sans arthrose. A propos de seize observations.

A series of 16 cases of chronic instability of the metacarpo-phalangeal joint of the thumb is presented. The authors begin by summarising the two main surgical procedures used in such cases: ligamentous reconstruction and arthrodesis. In our series, a ligamentous reconstruction with Smith's procedure was performed in 13 patients, a primary arthrodesis in 2 patients and a secondary suture in one patient. The results are analysed in 15 patients (7 women, 8 men) with a minimum followup time of two years. Failure was noted in 4 cases treated by ligamentous reconstruction (3 men and 1 woman). An arthrodesis was subsequently performed in all these patients. There were therefore a total of 6 arthrodesis and 8 ligamentous reconstruction to review. Ligamentous reconstruction gave better functional results than arthrodesis in particular as regards mobility, opposition of the thumb and strength of pinch grip (decreased by 50% with arthrodesis). In manual workers the use of ligamentous reconstruction in these cases was shown in our series to give inconstant results.

[Entrapment of the median nerve after dislocation of the elbow]. / Incarcération du nerf médian après luxation du coude.

Entrapment of the median nerve as a complication of a dislocation of the elbow has rarely been reported. The prognosis is worse in case of delayed diagnosis. Exploration surgery is indicated when neurological signs remain following reduction of a dislocation of the elbow.

Recent simple flexor tendon injuries in zone I, II, III of Verdan. Results of tendon repairs concerning 115 fingers in 99 patients.

In this study, the authors analyze 197 recent injuries of the flexor tendons of fingers in zones I, II and III of Verdan, without complex cutaneous lesions, associated with an injury of one or both digital nerves, but leaving safe at least one digital artery. Tendon repair is either followed by strict immobilization or by Kleinert's method of immobilization. Results concerning 115 reviewed injuries evaluated according to Kleinert's criteriae, show a net superiority of Kleinert's technique compared to strict immobilization. Global results are analysed according to the age, the finger injured and the presence of a work accident. Lesions treated by Kleinert's technique have been analyzed according to the zone of injury, the tendon injured in zone II and the existence or not of an injured digital nerve. After Kleinert's method, factors affecting the prognosis are lesions in zone II, injury of both tendons, lesions of the fifth finger, the responsibility of a "work accident". The authors conclude as to the correct time for repair, the tendons to be repaired and the type of injuries to be immobilized. They also emphasize the progress brought to the surgery of flexor tendons by Kleinert's method.

Fractures of the proximal end of the radius associated with other traumatic lesions of the upper limb. A report of seventy-three cases.

Closed isolated fractures of the radial head should be considered and managed in a different way from those associated with other traumatic lesions of the upper extremity. The recommended treatment for the radial head is early motion, with or without internal fixation or arthroplasty. For this to be achieved, surgical fixation of most of the associated fractures, and surgical repair of serious damage to capsular and ligamentous structures, should be performed. Indications are proposed, according to the results of a series of 73 cases which are compared with our series of 168 observations on isolated radial head fractures.

[Melorheostosis. Apropos of a localization in the hand]. / La mélorhéostose. A propos d'une localisation à la main.

The authors describe a case of melorheostosis localised in the hand. Melorheostosis is an unusual affection. The first signs appear in some cases at birth, but the disease is often diagnosed during the fourth decade. Clinical symptoms are pain, ankylosis, the deformation provoked by the lesion of soft tissues and especially limitation of motion. Radiographs permit the diagnosis: opacities parallel to the diaphysis with a "monomelic" topography. The natural history of the condition is characterized by the possibility of extension of the disease. Operative treatment is rarely indicated.

Treatment of isolated fractures of the proximal end of the radius in adults. Remarks concerning 168 cases.

The review of a series of 168 cases of isolated fractures of the upper end of the radius in adults allows the authors to note the advantage of functional therapy. The early physical therapy contributed to obtain an important rate of good results with the different types of Mason's classification. An osteosynthesis, when performed, must permit the early mobilisation of the elbow in order to avoid stiffness. Such a short experience does not allow the authors to conclude in favor of the necessity for the emergency use of a radial prosthesis instead of an isolated resection.

[Injury rupture of flexors of the index finger complicating subcutaneous dislocations of the semilunar bone]. / Rupture traumatique des fléchisseurs de l'index compliquant une énucléation sous-cutanée du semi-lunaire.

A case is reported here of an unusual case of rupture of the flexor tendons of the index finger in the carpal tunnel complicating a subcutaneous displacement of a lunate bone. This was combined with a carpal tunnel syndrome with hypoaesthesia. The treatment, taking account of the age of the patient and the relative tolerance to the dislocation, consisted of a simple resection of the lunate to free the medial nerve together with a partial graft of the flexor digitorum profundus.

[Subungual glomus tumor. A case of unusual form]. / Tumeur glomique sous unguéale. Un cas de forme inhabituelle.

The authors report a case of glomus tumour developing beneath the nail of the ring finger in a 95 year old woman. In contrast with other similar cases, the pain was moderate and had been present for 20 years. The bony phalanx was deformed. Microscopic examination confirmed the diagnosis of a glomus tumour developing in the soft tissues. The phalanx was amputated.

[A rare abdominal emergency: acute phlegmonous gastritis (author's transl)]. / Une urgence abdominale rare : la gastrite aiguë phlegmoneuse.

In the light of a series of recent observations and a personal case, the authors recall that acute phlegmonous gastritis is a rare disease usually secondary to a bucco-pharyngeal infective focus, characterised by an acute abdominal syndrome accompanied by a very severe infective context. Only laparotomy leads to the diagnosis. Since antibiotics, the mortality has regressed from more than 80% to less than 50%. The prognosis of the antral forms is much less serious than that of the diffuse forms with mortalities of 28% and 71% respectively. In antral gastritis the best therapeutic attitude is early antibiotic therapy associated with 2/3 gastrectomy.