CT guided pararectal seed implant for localized prostate cancer: a preliminary report.

One hundred and fifty-two patients were treated with CT guided pararectal prostate seed implant (CPSI) alone or in combination with external-beam 3D conformal radiation therapy (EB3DRT) and Androgen Blockage Hormone Therapy (HT). A decrease and normalization in PSA values was seen following treatment in all groups. However, a better therapeutic response was observed in the individuals that received CPSI and EB3DRT with hormone therapy.

[Does aesthetic surgery form part of mainstream surgery or is it an entirely separate sector? Reflections and proposals for better protection of the public]. / La chirurgie esthétique est-elle une chirurgie à part entière ou une chirurgie entièrement à part? Réflexions et propositions pour une meilleure protection du public.

In contempt of the laws and regulations in force, several thousand unqualified practitioners carry out aesthetic surgery although only a mere few hundred are legally entitled to practice this surgical specialty. We are aware, in the present system which has no efficient control systems, that the public is no longer able to identify this small group of charlatans and incompetents. We call on massive concerted effort by the responsible public authorities to ensure that the general public receives the necessary protection. Amongst others, we demand that: The ministry of health, integrates all medical products and medical devices aimed at the aesthetic sector into the list of medical products and medical devices to marketing authorization (authorization de mise sur le marché--AMM) or to endorsement in compliance with the Huriet Law of 10.12.1988. The conseil national de l'ordre des medecins, (national council of doctors advisory board), ensures that the laws and regulations in force governing the value of diplomas, qualifications and competences are respected, be aware of the obsolescence of the general nature of the medical degree, inapplicable due to the efficiency and thus the dangerous nature of modern medicine. The ministry of justice, clearly defines the nature of the informed consent demanded from the patient prior to any therapeutic treatment, ensures the conditions required for legitimate compensation for prejudices caused by therapeutic risks, specifies the doctor's responsibility without malpractice conditions, be aware of the perverse effects caused by the abandonment of the obligation of means and its replacement by an obligation of results demanded from the doctor, to correct the unjust and anomalous situation which opposes the ten year responsibility of the medical product or medical devices manufacturer with the thirty year responsibility of the doctor using these products or equipment.

Surgically assisted rapid palatal expansion: an outpatient technique with long-term stability.

This study presents the results of surgically assisted rapid palatal expansion done on an outpatient basis in 19 patients with a mean age of 30 years. Postsurgical and postorthodontic evaluation (mean, 2.4 years) showed a mean relapse rate of 8.8% in the canine region, 1% in the premolar region, and 7.7% in the molar region. These results show that the surgical procedure is feasible on an outpatient basis and the technique, as outlined, yields a stable long-term result.

Anatomic basis for use of a distal pedicle leg flap.

The cutaneous blood-supply of the limbs is ensured by three types of arteries: the large septo-cutaneous arteries, the slender musculocutaneous arteries, and the rare satellites of the cutaneous nerves. The skin cover of the outer aspect of the leg is particularly well vascularized thanks to its special situation, centered on the intermuscular septa bounding the outer compartment of the leg. Neuromuscular arteries are rare at this site, but there are numerous septo-cutaneous arteries at intervals along the septa. This anatomic study is based on 20 dissections and a radiologic survey and provides findings confirming the reliability of a distally based lateral leg flap. This pedicle arises from the fibular artery behind and the anterior tibial artery in front. It is situated, on average, 10.8 cm from the lateral malleolus, thus allowing coverage of peripheral losses of substances at the malleoli and heel.

[Treatment of loss of substance of the ankle or heel in adults. Apropos of a series of 88 cases]. / Traitement des pertes de substance de la cheville ou du talon chez l'adulte. A propos d'une série de quatre-vingt huit cas.

Cover of ankle and heel defects is always a difficult problem for the plastic surgeon. This complexity is due to the poor blood supply and the limited amount of surrounding soft tissue, as well as the high incidence of adjacent lesions. Apart from pressure sores in bedridden patients, skin defects in active patients, which require reconstruction to a state as close as possible to the premorbid state, are relatively rare. A plastic surgery unit is faced with this problem four or five times a year, on average. This low incidence means that each patient constitutes a particular case. There are no series in the international literature sufficiently large to establish any statistically valid data. The authors analyse a series of 88 cases of ankle or heel defects treated between 1982 and 1989 in the plastic surgery unit of CHU de Tours. They report their experience of the techniques used and define the indications in relation to the nature of the structures exposed and the weight-bearing or non-weight-bearing nature of the defect to be covered.

[Covering of ischial pressure sores using a fasciocutaneous flap from the posterior surface of thigh (modified Griffith method) after mattressing with the biceps femoris. Apropos of 11 cases]. / Couverture des escarres ischiatiques par lambeau fascio-cutané de face postérieure de cuisse (Griffith modifié) après matelassage par le biceps femoris. A propos de onze cas.

The ischial region is the commonest site for pressure sores in paraplegics capable of sitting. The choice of treatment must be guided by two imperatives: the need for a thick tissue cover (mattressing) and perfect trophicity, the risk of recurrence which always remains possible. The association of a modified Griffith fasciocutaneous flap from the posterior surface of the thigh and a hamstring muscle flap (preferably biceps femoris) providing mattressing of the ischial region, appears to satisfy these imperatives. The other repair procedures are discussed in order to ensure the best management of the paraplegic patient's cutaneous capital, due to the continual risk of a new pressure sore or a recurrence of the ischial pressure sore.

Cephalometric analysis of long-term airway space changes with maxillary osteotomies.

The cephalometric radiographs of 13 patients without sleep apnea who had undergone isolated maxillary surgery were studied. The authors found increases in both the nasopharyngeal and hypopharyngeal airway spaces 3 to 5 years after surgery. The results suggest that adaptive processes occur in both the upper and lower jaw, which contribute to an enlarged airway after surgery.

[Maxillary osteotomy: an alternative treatment concept for obstructive sleep apnea syndrome]. / Oberkieferosteotomien: ein alternatives Therapiekonzept zur Behandlung des obstruktiven Schlaf-Apnoe-Syndroms?

This study contributes to the evaluation of the question whether patients with obstructive sleep apnea syndrome might benefit from maxillary surgery. Changes in nasopharyngeal and hypopharyngeal airway spaces of 13 non-apneic patients following maxillary advancement and/or impaction osteotomies were studied retrospectively by cephalometric analysis. The data suggest a long-term increase in both nasopharyngeal airway space and unexpected, in hypopharyngeal airway space which remained stable over time. The clinical implications are discussed in view of previous studies which suggest or recommend orthognathic surgery as a treatment modality in selected patients with obstructive sleep apnea syndrome.

Long-term airway space changes after mandibular setback using bilateral sagittal split osteotomy.

Eleven patients were evaluated retrospectively for their long-term changes in hypopharyngeal airway space after surgical correction of mandibular hyperplasia. All patients had undergone mandibular setbacks by way of bilateral sagittal split osteotomies using rigid fixation. The cephalometric evaluation of hypopharyngeal airway space was based on stable craniofacial landmarks. The results of this study indicate that mandibular setback procedures create relative narrowing of the hypopharyngeal airway space, as seen on lateral cephalometric radiographs, which in isolated cases might contribute to the development of an obstructive sleep apnea syndrome. The 2-dimensional evaluation of hypopharyngeal airway space and the clinical implications of the results are discussed.

[Long-term alternations in the hypopharyngeal respiratory tract after mandibular setback]. / Langfristige Veränderungen im Bereich der hypopharyngealen Atemwege nach Unterkieferrückverlagerungen.

10 patients were evaluated retrospectively for their long-term changes in hypopharyngeal airway space after surgical correction of mandibular prognathism. All patients had undergone mandibular setbacks by way of bilateral sagittal split osteotomies with rigid fixation. The cephalometric evaluation of the hypopharyngeal airway space was based on stable craniofacial landmarks. The results of this study indicate that mandibular setbacks procedures create relative narrowing of the hypopharyngeal airway space, which in isolated cases might contribute to the development of an obstructive sleep apnea syndrome. The clinical implications of these findings are discussed.

[Technical analysis of reduction mammaplasty. A personal method]. / Analyse technique d'une mammoplastie de réduction. Une méthode personnelle.

The authors describe the evolution of their ideas concerning the principles of reduction mammaplasty. The elements for their analysis are based on a study of 1,287 cases of breast reduction following a pre-established technique. Basic concepts in preoperative markings and surgical techniques are discussed. Their conclusions lead to a surgical method, both simple and secure, avoiding unfavourable results, which may be a helpful guide for residents and young plastic surgeons.

[Inner canthus--anatomical junction. A surgical entity]. / Le canthus interne--carrefour anatomique. Entité chirurgicale.

The medial canthus is a surgical entity. The anatomical features are defined from a dissection of eight orbital regions. The pathways of carcinological invasion and the anatomical barriers are considered. The conclusions are discussed in the light of the data reported in the literature.

Health physics measurement of Princeton Tokamaks, 1977-1987.

The Princeton Plasma Physics Laboratory (PPPL) began fusion experiments in 1951. In the early years, the major health physics concerns were associated with x radiation produced by energetic electrons in the plasma. Within the past year, neutron and 3H production from 2H-2H (represented hereafter as D-D) reactions has increased significantly on the larger fusion devices. Tritium retention noted in graphite tiles underscores the significance of material selection in present and future 3H-fueled fusion devices. This paper reports on operational health physics radiation measurements made on various PPPL machines over the past 10 y.

[Maxillofacial injuries due to firearms. Retrospective study apropos of 60 cases]. / Traumatismes maxillo-faciaux par armes à feu. Etude rétrospective à propos de 60 cas.

Sixty cases have been treated between 1969 and 1986. The same primary treatment's principles have left for the last twenty years. Secondary treatment only, realized between the second and the third month has much benefited by plastic surgery's progress.

Zoladex (ICI 118,630): clinical trial of new luteinizing hormone-releasing hormone analog in metastatic prostatic carcinoma.

Twenty-seven patients with metastatic adenocarcinoma of the prostate were treated with the new luteinizing hormone-releasing hormone analog, Zoladex (ICI 118,630) for up to ninety-eight weeks. Initially, treatment was randomized between Zoladex 250 micrograms and 500 micrograms self-injected subcutaneously every day for a minimum period of twelve weeks following which a sustained-release, once-monthly depot formulation of Zoladex 3.6 mg s.c. was used. Acute rises in serum gonadotropins and testosterone during the first two days were followed by declines in hormone levels over the following three weeks. Median time to castration with 500 micrograms/day was twenty-two days compared with forty-three days with 250 micrograms/day (p = 0.06). No significant endocrinologic changes occurred during the transfer to the depot, and serum testosterone remained 95 per cent suppressed throughout the duration of the study. After three months the median daily serum Zoladex concentrations ranged between 0.47 and 0.53 ng/ml and were not significantly different among the three dosage forms. No specific correlation among serum Zoladex concentrations, endocrinologic parameters, and tumor response rates were found. Hot flashes initially, and decreased libido were the only common complaints. Zoladex was well tolerated, and no side effects required dose-modification or removal from the study. Tumor response rates up to one year appeared to be comparable to the conventional endocrine therapies. This analog in monthly depot formulation is recommended for further clinical evaluation.

Flow cytometric analysis of DNA content in human bladder tumors and irrigation fluids.

Flow cytometry (FCM) was used to study the DNA distribution of 99 tumor biopsy specimens and 41 bladder irrigation samples from patients with transitional cell carcinoma of the bladder. For tumor biopsy and cystectomy specimens, the frequency of aneuploidy increased with advancing tumor stage and grade. All T0 tumors were diploid. Twenty-seven percent of T1, 71.4% of T2, and 75% of T3 and T4 tumors were aneuploid. All Grade I tumors were diploid. Thirty percent of Grade II and 76.9% of Grade III tumors were aneuploid. The frequency of aneuploidy of tumors in the early stages (Ta, T1) is similar to the incidence of subsequent progression by these tumors described in the literature. For irrigation fluids, the relationship between grade and stage and the frequency of aneuploidy was similar to the relationship seen with tumor specimens. All four patients with only carcinoma in situ had aneuploid cells in their irrigations. The comparison of FCM data of bladder biopsy and bladder irrigation from the same cystoscopic evaluation suggests adequate representation of tumor cells in the irrigation fluids for almost all cases. The authors conclude that DNA ploidy analysis by FCM appears useful in a clinically important group of patients with aneuploid superficial tumors of moderate or high grade. Bladder irrigation analysis appears useful in the follow-up of patients with a history of carcinoma in situ and those with aneuploid tumors.

Formation of lipid-linked oligosaccharides by MOPC 315 plasmacytoma cells. Decreased synthesis by a nonsecretory variant.

MOPC 315 is a BALB/c plasmacytoma which secretes a trinitrophenol-binding IgA lambda 2 paraprotein. We have investigated the incorporation of [3H]mannose into lipid-linked oligosaccharide precursors in wild-type MOPC 315/J and variant nonsecretory 315/P cells. In pulse labeling experiments, no differences could be detected in the ability of the two cell types to incorporate [3H]mannose into lipid-linked oligosaccharides containing 5 or less mannose residues. In contrast, quantitation of the incorporation of [3H]mannose into larger lipid-linked oligosaccharides and proteins revealed a 49 and 40% decrease, respectively, in the 315/P cells compared to wild-type cells. Further characterization of the lipid-linked structures documented a marked decrease in glucosylated oligosaccharides isolated from 315/P cells. When membranes from the two cell lines were analyzed for their ability to transfer [3H]glucose from UDP-[3H]glucose to [3H]glucosylphosphoryldolichol, an apparent deficiency was noted in the 315/P preparations. However, if assay conditions were adjusted to include AMP in the reaction mixtures, no differences in the in vitro synthesis of [3H]glucosylphosphoryldolichol or [3H]glucose-labeled oligosaccharide-lipid could be detected. In these reactions AMP was found to prevent hydrolysis of UDP-[3H]glucose by inhibiting nucleotide pyrophosphatase (EC 3.6.1.9), the specific activity of which was determined to be more than 100 times greater in variant 315/P compared to wild-type MOPC 315/J cells. This large difference in specific activity was not accompanied by similar differences in the activity of several other enzymes analyzed. A decrease in whole cell UDP-glucose pool size was not detected in 315/P cells. Therefore, if nucleotide pyrophosphatase is important for the control of substrates for glycosylation, it must regulate nucleotide sugar levels at a site other than the cytoplasm of cells, perhaps at the location of synthesis of the larger lipid-linked oligosaccharides.