Results of Toccata® resurfacing PIP joint arthroplasty. A series of 32 cases at a mean follow-up of 5.9 years.

The objective of this study was to evaluate the long-term results of proximal interphalangeal (PIP) resurfacing arthroplasty for treating osteoarthritis: the PIP Toccata implant®. This was a retrospective study of 32 out of 33 PIP arthroplasty cases performed with a dorsolateral or a Chamay approach by two surgeons after a minimum follow-up of 24 months. Patients were reviewed using a standardized assessment of pain, function, mobility and radiological changes. The average follow-up was 5.9 years. The mean active range of motion was 67° (15-95). Radiographic analysis found osteointegration of the implant in all patients except one, in whom distal migration had no clinical consequence. Heterotopic ossifications (HO) developed in 10 of the 20 cases where the implant was inserted through a lateral approach. Intra-articular bone debris was identified in the first postoperative X-ray in most of these cases. The presence of HO was significantly correlated with decreased range of motion (P<0.05). Six patients required surgical revision and two needed implant removal and arthrodesis. Our results are comparable to other published studies of PIP resurfacing arthroplasty. It is important to remove all bone debris when using the dorsolateral approach. The PIP Toccata® implant is a reliable solution for treating PIP osteoarthritis but this arthroplasty procedure is demanding.

[Experience with the regionalization of transfusion advice]. / Expérience de régionalisation du conseil transfusionnel.

We represent an organization of transfusionnel advice at a regional level and we develop arguments and stages having allowed us to lead to this choice. This target was reached in two stages, which took place over 3 years. The regional transfusionnel advice leans on three fundamental points: a planned permanent organization, skilled and formed actors as well as adapted tools. Tending to a homogeneous organization between every blood bank center seems to be coherent towards the current configuration of blood donation in France.

[Partnership guide for the good sequence of a blood donation]. / Guide de partenariat pour le bon déroulement d'une collecte de sang.

Blood donation requires a partnership for its organization between Etablissement français du sang and associations. A partnership guide, conceived by and for the operations team in the first rank of which Associations for Altruistic Blood Donation, was worked out to remind or inform conditions necessary for the good sequence of a blood donation. Through this guide, the authors also wanted to clarify the role and the responsibilities of each partner for a better reception of the Candidate for donation. The elaboration of this guide is only a first stage towards an homogenization or even an overhaul of the organization of blood donation.

Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d'étude des tumeurs à calcitonine.

BACKGROUND: Prognostic factors of sporadic or inherited medullary thyroid carcinoma (MTC) are still controversial and have been assessed in old and small series. A better knowledge of these factors would improve patient management. OBJECTIVE: To evaluate factors involved in the prognosis of MTC in a large series of cases, using uni- and multivariate analysis. DESIGN AND PATIENTS: Clinical, biological, surgical and epidemiological data on 899 MTC patients, diagnosed between 1952 and 1996, were collected by the French Calcitonin Tumors Study Group (GETC) with a standardized questionnaire, and processed in a national database. MEASUREMENTS: Survival and biochemical cure (i.e. normal basal post-operative serum calcitonin levels) were analysed with Kaplan and Meier and log-rank test statistical procedures. Data are presented as adjusted rather than observed survival, to consider only patients who died of MTC. Cox's forward-stepping proportional hazard model was used to analyse factors with a significant influence on survival by univariate analysis. RESULTS: Apart from the large proportion of familial forms (43%), the general characteristics of our population were similar to those in other studies: mean age at surgery = 43.4 years; sex ratio = 1 male/1.35 female; stage I = 20.8%; stage II = 21.2%; stage III = 46.5% and stage IV = 11.5%. 863 (96%) patients underwent surgery; 43% of operated patients were biochemically cured. Adjusted survival was 85.7 +/- 1.5% at 5 years and 78.4 +/- 2.1% at 10 years. Multivariate analysis showed that age and stage were independent predictive factors of survival. Gender, type of surgery, type of familial form were predictive only in univariate analysis. Biochemical cure predicts a survival rate of 97.7% at 10 years. Authentic recurrence, that is subsequent elevation of calcitonin (CT) after post-operative normalization, was found in 4.9%. In non-cured patients (57%), survival was still good: 80.2% (+/- 2.2%) and 70.3% (+/- 2.9%) at 5 and 10 years, respectively. Similarly, prediction of biochemical cure was solely dependent on stage. CONCLUSION: Survival of these medullary thyroid carcinoma patients appears better than expected even in non-cured patients. Considering the strong impact of stage, the necessity for pre-operative diagnosis of MTC is obvious.

[Urokinase (in situ) in the case of acute ischemia of the lower limbs (author's transl)]. / L'urokinase in situ dans l'ischémie aiguë des membres inférieurs.

Eighteen patients with severe, acute ischemia of the lower limbs were treated with an arterial perfusion of the ischemic leg with Urokinase. This was associated, in thirteen patients, with a limited attempt of revascularization. The result of this treatment was an immediate improvement in twelve cases, which lasted, more than six months, in six patients. The authors insist on the interest of the arteriography performed after the fibrinolytic treatment in order to complete the revascularization.