[Technical notes on mastectomy performed as part of transsexualism F to M]. / Notes techniques relatives à la mastectomie pratiquée dans le cadre du transsexualisme F à M.

Mastectomy in case of large breast should use a particular technique. The principle of mastectomy by periareolar flap or higher in MAP must be abandoned in favor of mastectomy by lower horizontal with the office of the WFP transformed by a tummy. Main technical note contains the plasty in MAP because the conventional mastectomy is well known.

[Labial sequels after uni- and bilateral cleft lip repair]. / Les séquelles labiales dans les fentes uni- et bilatérales.

Children born with labial-alveolar-velopalatine clefts must be managed by multidisciplinary teams in order to decrease the frequency and the importance of sequels, by implementing a true therapeutic strategy. It is indeed easier to avoid a secondary deformation than to correct it. Labial sequels are often associated to nasal sequels, and are managed in a single surgical intervention, with total revision of the cheilorhinoplasty. Some less important labial deformities can be corrected without total and simultaneous revision of the lip-nose complex. The goal of correction is functional and aesthetic, and the choice of the moment depends mainly on the psychological impact of the deformation for the child, and his motivation for reoperation.

[Therapeutic approach of cleft lip and palate at Caen University Hospital]. / Prise en charge des fentes labio-maxillo-palatines au centre hospitalier universitaire de Caen.

The therapeutic approach of facial cleft in Caen University Hospital depend on two teams: primary treatment by the Pediatric Plastic Unit (60 cases/year), and secondary treatment by the department of Plastic and Maxillofacial Surgery (more than 30 cases/year). The lip closure is realised before the age of one month with the Tennisson's technic. The palate closure is performed between 6 and 12 months old. Each patient is presented at a multidisciplinary consultation which include a surgeon, an orthodontist, an orthophonist, a psychologist and otologist. At about 5 years old, the orthodontic approach begins with palatal expansion with a modified quadhelix to prepare function its treatment is underwent at this age too. After the age of 9-10 years the orthodontic treatment continued on the permanent teeth. If necessary, the sequelae on maxilla, lips and nose are treated at the end of the adolescence.

[First heterotopic ovarian autotransplantation in the female]. / Première autotransplantation ovarienne hétérotopique chez la femme.

Treatment of subdiaphragmatic Hodgkin's disease with combined radio and chemotherapy results in castration of more than 80% women treated, despite oophorepexy. Several types of oophorepexy (lateral and medial transposition), have been described in the literature. None warranted sufficient schelter to avoid frequent alteration of ovarian function and fertility. We suggest a news technique of subcutaneous ovarian grafting which provides full protection against irradiation. To be successful, this technique requires the creation, prior to grafting, of a receptive cavity, two surgical teams working together, and the use of an operative microscope during transplantation. A mature oocyte was collected by puncture of the ovary containing cavity one year after the operation. Two years later, ovarian cycles remain regular, and follicle growth occurs normally each second of third cycle on the transplanted ovary.

A new technique to protect ovarian function before pelvic irradiation. Heterotopic ovarian autotransplantation.

The authors describe a new technique for the subcutaneous heterotopic transplantation of the ovary before pelvic irradiation to treat Hodgkin's disease. Creation of a cavity to receive the transplant and the use of two surgical teams and the surgical microscope during the operation ensured its successful outcome. The transplanted ovary was followed up clinically and by ultrasound monitoring: ovarian cycles remained regular despite radiotherapy, and follicle growth occurred normally. In comparison to other types of oophoropexy described in the literature, the advantages of this technique included total protection of the ovary from irradiation, and conservation of ovarian function and fertility. One year after the procedure, puncture of the ovarian compartment produced a mature oocyte specimen.

[Heterotopic autotransplantation of the ovary in women]. / Autotransplantation ovarienne hétérotopique chez la femme.

Treatment of subdiaphragmatic Hodgkin's diseases with combined radio- and chemotherapy results in castration of more than 80% of the women treated, despite oophoropexy. We suggest a new technique of subcutaneous ovarian grafting which provides full protection against irradiation and preserves both ovarian function and fertility. To be successful this technique requires the creation, prior to grafting, of a receptive cavity, two surgical teams working together, and the use of an operative microscope during transplantation. A mature oocyte was collected by puncture of the ovary-containing cavity one year after the operation.

[Epithelioid sarcoma. Apropos of 3 cases]. / Les sarcomes épithélioïdes. A propos de trois cas.

The authors present two cases of epithelioid sarcoma of the hand and one of the foot with clinical interest. This recently described tumor (Enzinger, 1970), is relatively rare. It occurs in the hand, forearm, pretibial region and foot and affects principally young adults. It should be emphasized, and this is borne out in the literature, that this tumor may appear perfectly benign and often has a course of long duration. The difficulty of clinical and especially of histologic diagnosis as well as the difficulty of determining the boundaries of extension of the tumor make it necessary to carry out radical surgery (amputation or rarely block excision). Every author agrees that local excision is to be condemned, there being an 85% recurrence rate. Spread of the tumor is by way of the fascial planes and tendon sheaths. Lymphatic and pulmonary metastases occur particularly when there is vascular invasion.

Epithelioid sarcomas. Three cases.

The authors present two cases of epithelioid sarcoma of the hand and one of the foot with clinical interest. This recently described tumor (Enzinger, 1970), is relatively rare. It occurs in the hand, forearm, pretibial region and foot and affects principally young adults. It should be emphasized, and this is borne out in the literature, that this tumor may appear perfectly benign and often has a course of long duration. The difficult of clinical and especially of histologic diagnosis as well as the difficulty of determining the boundaries of extension of the tumor makes it necessary to carry out radical surgery (amputation or rarely block excision). Every author agrees that local excision is to be condemned, there being an 85% recurrence rate. Spread of the tumor is by way of the fascial planes and tendon sheaths. Lymphatic and pulmonary metastases occur particularly when there is vascular invasion.

[Carpal tunnel syndrome]. / Le syndrome du canal carpien.

The authors have reviewed 250 cases of carpal tunnel syndrome operated upon in a series of more than 400 cases. They also describe the results of an experimental study of the effects of locally injected corticosteroids on nervous fibers. Following a brief historical introduction, a detailed anatomical description is provided, with emphasis on congenital variations. The pathological, histological and clinical features of the disease are reviewed in the light of modern concepts of nerve compression. The cases in this series are classified according to their cause, among which idiopathic hypertrophic tenosynovitis was predominant. With regard to treatment, the authors conclude from their experience that repeated local injections of corticosteroids are dangerous, whereas surgical treatment is harmless and can be performed on out-patients under regional anaesthesia.

[Effects of local corticoids on the nerve fiber. Experimental study (author's transl)]. / Action des corticoïdes locaux sur la fibre nerveuse. Etude expérimentale.

The intra-operative establishment of some impairments of the median nerve, in patients who are operated for carpal tunnel syndrome and who previously received several local injections of corticoids, led the authors to try to see the respective responsibility of the compression and of the injection in the degenerative process. In 60- dog cubital nerves, it has been possible, to study different parameters by intra and perineural (recurrent or not injections: the puncture, the dilatation, the solvents, the benzylic alcool and two long action corticoids very often used (triamcinolone acetonide, cortivazol). In the first of our series, the injections were done around the nerve and inside the nerve under visual or blind control (as for an infiltration). The nerves are then cut off after 1, 2, or 3 months. In the second of our series, the injections were done in the same way, but recurrently on the first, second and third month, and the nerve was cut off within the fourth month. An electrophysiological study was performed before taking the samples; they were then prepared for reading on the optical and electron microscope. The results show lesions characterized by an epineural spumous sediment, a localized decrease in the large fibers under the perineurium in the first and second series. These impairments seem to be diminishing with time. However when the injections are done recurrently, the lesions are more important, showing a wallerian degeneration and regeneration.

Surgical importance of the radio-automatic study of the arterial vascularization of the forefoot.

The authors have studied anatomically and angiographically 50 cadaveric foot specimens, emphasizing; the vascular flow predominance between dorsalis pedis and plantar arteries; the anastomosis between the three arterial supplies in the foot; the dividing pattern and the distribution of each artery; the blood flow distribution pattern at the level of the first and second toes and especially the anastomosis between the dorsal and plantar vessels and the branches for the metatarsic-phalangeal joint. The study presents new data about the indications of preoperative angiography of the forefoot, about the surgical technique of toe transfer, articular transposition and multiple transposition (2 toes, skin and bone...).

Current aspects of tuberculous tenosynovitis. A report of six cases.

Tuberculosis of tendon sheaths of the hand was rare before the advent of antituberculous drugs. It seems now-a-days exceptional, for the published series become more an more uncommon and smaller. Therefore, the diagnosis is often an operative surprise on a patient with a painless, gradually developing tenosynovitis. No patient suffered from other active tuberculosis. But two of them had an old history of tuberculosis (knee and kidney). Analysis of other cases is inconclusive about the relation ship between trauma and tuberculosis. Histology and cultures establish the diagnosis. Surgical treatment consists in large excision of involved tissues. The damages provoked by the illness are often important, with sometimes tendon ruptures. However, functional results are surprisingly not so bad. Antituberculous drugs are the backbone of the surgical treatment for several months.