Which surgery should be offered for carpal tunnel syndrome in a patient who was previously treated for recurrence on the contralateral side? Preliminary study of 13 patients with the Canaletto® implant.

There are no published studies on the management of carpal tunnel syndrome (CTS) patients who have already been operated for recurrent CTS on the contralateral side. The aim of this study was to evaluate 13 patients with CTS who underwent primary release using a Canaletto® implant. The 13 patients had all been operated for recurrent CTS previously. On the contralateral side, they all had subjective signs, and two of them already had complications. All were operated with the Canaletto® implant according to Duché's technique, in a mean of 20minutes. After a mean 19.3-month follow-up, paresthesia, pain, and QuickDASH scores were significantly improved, even in one patient who underwent revision at another facility. This preliminary study suggests that use of a Canaletto® implant as first-line treatment for CTS in patients who already underwent revision surgery on the other side is a simple and safe technique, without worsening of symptoms. These findings should be assessed with a prospective randomized controlled trial.

[The abdominal drop flap]. / Le lambeau de recul abdominal.

The skin between the mastectomy scar and the future infra-mammary fold may be managed in different ways in delayed breast reconstruction using a DIEP (deep inferior epigastric perforator). Conserving this skin and positioning the flap skin paddle in the middle of the breast usually highlights skin color disparity because of two visible transition zones. Resection of the entire skin under the scar may be more aesthetic but limits direct closure possibility in case of flap failure. In order to benefit from both aesthetic result and safe surgical method, we propose the abdominal drop flap. The inferior thoracic skin flap is detached from the thoracic wall beyond the future infra-mammary fold, preserved and pushed under the breast.

[Laparoscopic cystectomy and ileal conduit urinary diversion for neurogenic bladders and related conditions. Morbidity and better quality of life]. / Cystectomie cœlioscopique et urétérostomie transiléale pour vessies neurologiques et assimilées. Morbidité et amélioration de la qualité de vie des patients.

OBJECTIVES: To assess morbidity and functional consequences of laparoscopic cystectomy with ileal conduit urinary diversion: in neurologic patients. MATERIALS: We reviewed the records of forty-two patients (ten men and thirty-two women) who underwent surgery between August 2007 and October 2013. The median age of the patient was 54 years old (range between 21-79 years). A laparoscopic cystectomy was performed followed by a short laparotomy to perform the ileal conduit urinary diversion. Records were reviewed to retrieve the indications and describe the postoperative and functional course. Patients and GPs were interviewed during phone calls to appreciate the quality of life by the PGII scale in order to assess the functional outcome. RESULTS: The operation was performed on 42 patients, of whom 18 had multiple sclerosis, nine a post-traumatic neurogenic bladder. Among the total population, 10 patients (23.81%) required a transfusion of at least one packed red blood cells (1-7). The overall rate of early complications was 35.71%. Belated complications were seen in 52.38% of the population. The median duration of hospital stay was 16 days (range between 9-70 days). The median follow up was 34 months (range between 1-76 months). For patients, the PGII scale rating had a median value of 6 (2-7). All referring physicians described a better functional status. CONCLUSION: The laparoscopic cystectomy can make postoperative course smoother for the neurological patients. However, the surgeon must weigh individually the benefit of performing the operation.

Vulvar reconstruction by a "supra-fascial" lotus petal flap after surgery for malignancies.

OBJECTIVE: The aim of this study is to report on our experience with the supra-fascial lotus petal flap following the resection of vulvar cancer. METHODS: The original lotus petal flap or gluteal-fold flap technique was initially described with fascial elevation. However, flap harvesting in a supra-fascial plane is feasible. Between 2008 and 2011, we performed and evaluated this modified flap technique for labia majora reconstruction on five elderly females (mean age: 72 years). RESULTS: Resection and reconstruction were performed in the same operative time with a median time procedure of 118 min. We observed neither flap failure nor partial necrosis. Functional evaluation beyond six months showed low donor site morbidity and good aesthetic results. CONCLUSION: Immediate vulvar reconstruction with supra-fascial lotus petal flap is a fast, easy and reliable procedure. It enables wide resection and safety margin following tumor removal with free tension suture, good aesthetic results and a favourable functional outcome.

Fungal bioconversion of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4-dichlorophenol (2,4-DCP).

Ninety strains of fungi from the collection of our mycology laboratory were tested in Galzy and Slonimski (GS) synthetic liquid medium for their ability to degrade the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) and its by-product, 2,4-dichlorophenol (2,4-DCP) at 100 mg l(-1), each. Evolution of the amounts of each chemical in the culture media was monitored by HPLC. After 5 days of cultivation, the best results were obtained with Aspergillus penicilloides and Mortierella isabellina for 2,4-D and with Chrysosporium pannorum and Mucor genevensis for 2,4-DCP. The data collected seemed to prove, on one hand, that the strains responses varied with the taxonomic groups and the chemicals tested, and, on the other hand, that 2,4-D was less accessible to fungal degradation than 2,4-DCP. In each case, kinetics studies with the two most efficient strains revealed that there was a lag phase of 1 day before the onset of 2,4-D degradation, whereas there was none during 2,4-DCP degradation. Moreover, 2,4-DCP was detected transiently during 2,4-D degradation. Finally, M. isabellina improved its degradation potential in Tartaric Acid (TA) medium relative to GS and Malt Extract (ME) media.

Enhanced degradation of fluorene in soil slurry by Absidia cylindrospora and maltosyl-cyclodextrin.

This study investigates the fungal biodegradation of fluorene, a polycyclic aromatic hydrocarbon, in liquid medium and soil slurry. Fungal strains and cyclodextrins were used in order to degrade fluorene and optimize fluorene bioavailability and degradation in soil slurries. After a procedure of selection in solid and liquid media, maltosyl-cyclodextrin, a branched cyclodextrin was chosen. 47 fungal strains isolated from a contaminated site were tested for biodegradation. Results showed the greater efficiency of "adapted" fungi isolated from contaminated soil vs reference strains belonging to the collection of the laboratory. These assays allowed us to select the most efficient strain, Absidia cylindrospora, which was used in a bioaugmentation process. Bioaugmentation tests were performed in an artificially contaminated non-sterile soil. In the presence of A. cylindrospora, more than 90% of the fluorene was degraded within 288 h, while 576 h were necessary in the absence of fungal bioremediation. It also appeared that biodegradation was enhanced by amendment with previously selected maltosyl-cyclodextrin. The results of this study indicate that A. cylindrospora and maltosyl-cyclodextrin could be used successfully in fluorene bioremediation systems.

Influence of surfactants on solubilization and fungal degradation of fluorene.

Eighteen fungal strains were tested in toxicity assays with surfactants in order to select surfactants and strains tolerant to surfactants for degradation assays. Two nonionic surfactants were used, an alkylphenol ethoxylate, Triton X-100, a sorbitan ester, Tween 80 and an anionic surfactant, sodium dodecyl sulfate. Solubilization and biodegradation tests were conducted in liquid medium batch; fluorene was quantified by HPLC. Results showed the enhancement of fluorene solubilization by the three surfactants, good tolerance of nonionic surfactants by the fungal strains and the enhancement of the biodegradation of fluorene by Doratomyces stemonitis (46-62%) and Penicillium chrysogenum (28-61%) in the presence of Tween 80 (0.324 mM) after 2 days.

[Effect of cyclodextrins on fungal degradation of fluorene]. / Effet des cyclodextrines sur la dégradation fongique du fluorène.

The purpose of this study was to improve the bioavailability of fluorene (PAH) by the use of complexing agents, cyclodextrins. The biodegradation tests were performed in liquid medium batches; fluorene was quantified by HPLC. Experimental results showed the enhancement of fluorene degradation by Penicillium italicum and Phanerochaete chrysosporium in the presence of branched cyclodextrins.

Fungal degradation of fluorene.

A selection of 30 strains of micromycetes known as good degraders of polychlorinated aromatic compounds, mostly isolated from soil and belonging to various taxonomic groups, have been investigated to degrade fluorene. Toxicity assays, first evaluated on solid media, have shown high growth inhibition at concentrations above 0.001 g l-1 only towards 23% of strains. Degradation of fluorene (0.005 g l-1) was then investigated in liquid synthetic medium for 2 days and evaluated by HPLC. Among the 30 strains tested, 12 could be considered as best degraders because of a rate of degradation at 60% or over. 3 strains of Cunninghamella genus were very efficient (mean of degradation: 96%) but different strains from Ascomycetes. Basidiomycetes and Deuteromycetes were also efficient 11 strains are not yet reported in the literature: Aspergillus terreus, Bjerkandera adusta, Ceriporiopsis subvermispora, Colletotrichum dematium, Cryphonectria parasitica, Cunninghamella blakesleeana, C. echinulata, Drechslera spicifera, Embellisia annulata, Rhizoctonia solani and Sporormiella australis. A metabolic approach with standard compounds (9-fluorenol and 9-fluorenone) indicated the presence of these monooxygenated derivatives for most of the strains.

Exserohilum israeli, a new species isolated from soil from Timna Park (Israel), and its physiological properties.

Fungi isolated from soil in Timna Park (Israel) were found to belong to a new species of Exserohilum for which the name Erserohilum israeli sp. nov. is proposed. The main physiological properties of members of this species are discussed and the influence of temperature and copper concentrations on the growth and morphology of the fungus were investigated.

Antimicrobial and antitumor activities of mycosporulone.

The conditions for optimal production of mycosporulone (1) are given. Its cytotoxic, antimicrobial, and antitumor activities are described. The biological activities of 1 were compared with those of known antibacterial, antifungal, and antitumor agents. The compound was particularly active against Pseudomonas aeruginosa and Staphylococcus aureus (resistant to penicillin). Compound 1 was not toxic to normal human cells (MRC(5)), although it exhibited cytotoxic activity against the human tumor cell lines MDA-MB 231 and PC(3) and the murine L-1210 leukemia cell line.

Effects of culture parameters on the degradation of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4-dichlorophenol (2,4-DCP) by selected fungi. Groupe pour l'Etude du Devenir des Xénobiotiques dans l'Environnement (GEDEXE).

In order to enhance 2,4-D and 2,4-DCP degradation by four selected fungi (Cunninghamella elegans, C. echinulata, Rhizoctonia solani and Verticillium lecanii), three culture parameters (initial chemical concentration, amounts of glucose and nitrogen) were varied. The levels of both xenobiotics in the culture media were monitored by HPLC analysis after five days of cultivation. The best results were obtained at low initial concentration (20 mg.L-1 vs 100) and with low amounts of glucose (5 g.L-1 vs 10) and nitrogen (2.4 mM vs 24). When these two elements were lacking from the culture media, biodegradation was not suppressed, but took place to a lesser extent. Thus, initial chemical concentration and amounts of carbon and nitrogen, in the culture medium, were shown to strongly influence the extent of 2,4-D and 2,4-DCP removal by fungi.

Degradation of three phenylurea herbicides (chlortoluron, isoproturon and diuron) by micromycetes isolated from soil.

As part of a study conducted on the fate of xenobiotics in the environment, a selection of 100 strains of micromycetes (Ascomycetes, Basidiomycetes and Yeasts) have been cultivated in liquid synthetic medium with 3 phenylurea herbicides: chlortoluron and isoproturon (100mg L-1) and diuron (20mg L-1). While 17 strains depleted isoproturon over 50% only 4 depleted diuron and 2 chlortoluron at the same level. The best results were obtained with Bjerkandera adusta and Oxysporus sp which were the most efficient towards the 3 substrates. After 2 weeks Bjerkandera adusta depleted chlortoluron 98%, diuron 92% and isoproturon 88%.

[Waterborne microbiological risk assessment: a state of the art and perspectives]. / Evaluation du risque microbiologique d'origine hydrique: un état de l'art et des perspectives.

Microbiological contamination is the most common threat related to drinking water. In developed countries, the current health system provides a good level of protection. However, some facts point out the need to develop further tools for better management of the waterborne risk. Several outbreaks have occurred in the United-States in the past decade. They were most often caused by tap water contamination associated with parasites and viruses, despite good compliance of the water treatment procedures. The chemical risk assessment methodology set up at the end of the 70's can now be applied for microbiological risks. This approach allowed the US authorities to improve their control on waterborne infection risks. Although limited, surveillance data suggest that to date. France has not encountered such outbreaks. However, the baselines and principles of risk management in that area should be also be optimized and updated. This work underlines the limits of the current risk management system. A literature review on microbiological risk assessment is first presented. Applications of this methodology are then commented, advantages and limits of the microbiological risk assessment approach in France are discussed.

Degradation of phenolic and chloroaromatic compounds by Coprinus spp.

Three species of Coprinus: C. sp, C. cinereus and C. micaceus were compared on solid media for some aspects of their physiological behaviour and cultural requirements (temperature, pH, substrate). Constitutive extracellular enzymatic activities were also determined. The Coprinus spp. exhibited different physiological and cultural features. Cultures of the 3 Coprinus species in synthetic liquid medium showed an efficient degradation of phenolic lignin model compounds (catechol, ferulic acid, guaiacol, phenol, protocatechuic acid syringic acid and vanillic acid) and pentachloronitrobenzene, while pentachlorophenol was not metabolized after 5 days perhaps because of a strong adsorption on mycelial biomass. It was suggested that phenoloxidases were not necessarily required for the metabolization of these compounds. Coprinus species may share a common degrading system for monomeric phenolic and chloroaromatic compounds.

Biodegradation of anthracene by soil fungi. Groupe pour l'Etude du Devenir des Xénobiotiques dans l'Environnement (GEDEXE).

A selection of 39 strains of micromycetes known as good degraders of polychlorinated aromatic compounds, mostly isolated from soil and belonging to various taxonomic groups, have been investigated for anthracene degradation. Toxicity and consumption assays, first evaluated on solid media, have not shown any toxicity of anthracene (1-100 mg.L-1) towards fungi. Degradation of anthracene (10 mg.L-1) was then investigated in a liquid synthetic medium for 4 days and evaluated by HPLC. Among the 39 strains tested, 19 degraded anthracene at 50% or more. Zygomycetes appeared to be the most efficient group (mean degradation : 81%) while Melanconiales were the least efficient (mean: 14%). Among 19 efficient strains, 8 had not yet been reported in the literature: Cryphonectria parasitica, Ceriporiopsis subvermispora, Oxysporus sp., Cladosporium herbarum, Drechslera spicifera, Verticillium lecanii, Fusarium moniliforme var. subglutinans and Rhizopus arrhizus.

Soil mycoflora from the Dead Sea Oases of Ein Gedi and Einot Zuqim (Israel).

Samples were taken from the top 10 cm of soils from 24 points in the Ein Gedi area. Among 329 isolates, 142 species were identified: 11 genera of ascomycetes, one genus of coelomycetes, 28 genera of hyphomycetes, 7 genera of zygomycetes and one yeast, in addition to some unidentified basidiomycetes. The hyphomycetes were represented by 17 dematiaceous, 9 mucedinaceous and two tuberculariaceous. Melanconiaceous and stilbellaceous genera were not found. Two new varieties of Microascus recently described were reisolated. No strict thermophiles or halophiles were obtained. There is apparently no very characteristic or specific fungal flora of the Dead Sea Oases although it was different from that found in the desert soil surrounding this area.

Fungal microflora biodiversity as a function of pollution in Oued Sebou (Morocco).

An inventory of the fungal microflora present in sediments collected at 11 sites along Oued Sebou has been established. The influence of some climatic parameters (temperature, rainfall) and of pollution on the composition of the fungal communities has been questioned. Emericella nidulans, Eurotium amstelodami, Neosartotya fisheri var. glabrum (Ascomycetes), Dreschslera biseptata (Dematiaceae), Penicillium citrinum (Mucedinaceae) and Phoma sp. (Sphaeropsidale) can be considered as strains sensitive to pollution. Penicillium janthelinum, Trichoderma koningii (Mucedinaceae) and Candida albicans (Yeast) were found only at the most polluted sites; Talaromyces flavus (Ascomycete) Rhodotorula rubra, Saccharomyces cerevisiae (Yeasts) and Fusarium oxysporum (Tuberculariales) were more often found at heavily polluted sites than at lightly polluted ones.

Novel methods for identification and quantification of the mushroom nephrotoxin orellanine. Thin-layer chromatography and electrophoresis screening of mushrooms with electron spin resonance determination of the toxin.

Orellanine, (2,2'-bipyridine)-3,3',4,4'-tetrol-1,1'-dioxide, the toxin from several Cortinariace species, induces an acute renal failure which can be very severe or even irreversible and fatal. It is therefore important to be able to quickly and simply identify orellanine in mushroom samples with classical methods, readily available in any laboratory, such as anti-poison centers. This article reports the results of three analytical methods: classical TLC on cellulose plates in n-butanol--acetic acid--water and two original methods, electrophoresis on agarose gel and direct electron spin resonance (ESR) after enzymatic oxidation. They were applied to detect orellanine in 34 Cortinariaceae and 4 other species of toadstools. Our three sets of results are convergent. TLC (detection limit: 15 ng with fluorescence densitometry), electrophoresis (25 ng) and even ESR (5 micrograms), are sensitive enough for our purpose, and a sophisticated method like HPLC (detection limit: 50 pg) is not required. As the ESR spectrum of the toxin semiquinone is highly specific, TLC or electrophoresis coupled with ESR are a convenient alternative to liquid chromatography coupled with mass spectrometry, with the same specificity, for a confirmation or with samples such as ours with high toxin contents. ESR unambiguously confirms the relatively high contents of orellanine, from 0.45% (C. henrici) to 1.1-1.4% (C. orellanus), found in five Cortinarius from the subgenus Leprocybe, section Orellani. The five species, though they are from different geographic origins, have a more or less common pattern of fluorescent compounds, among which orellinine and orelline beside orellanine. It can be useful to note that orellanine semiquinone can be easily detected by ESR directly in the fresh mushroom. The toxin is absent in the other mushrooms we tested, especially in D. cinnamomea and C. splendens, which have been claimed as toxic and suspected to contain orellanine.