Lysophosphatidic acid as a phospholipid mediator: pathways of synthesis.

From very recent studies, including molecular cloning of cDNA coding for membrane receptors, lysophosphatidic acid (LPA) reached the status of a novel phospholipid mediator with various biological activities. Another strong argument supporting this view was the discovery that LPA is secreted from activated platelets, resulting in its appearance in serum upon blood coagulation. The metabolic pathways as well as the enzymes responsible for LPA production are poorly characterized. However, a survey of literature data indicates some interesting issues which might be used as the basis for further molecular characterization of phospholipases A able to degrade phosphatidic acid.

[Osteoarticular involvement in parasitic diseases: bone mycetoma]. / Atteintes ostéo-articulaires d'origine parasitaire: les mycétomes osseux.

Mycetoma remains a common pathology in tropical areas. Diagnosis, based on mycology and pathology is still frequently late and treatment often leaves severe functional disorders. Medical imaging is indispensable to evaluate disease spread to bone tissue. Plain radiograms usually show cortical erosion, defects with sclerosing margins, and bone thickening. CT is the most sensitive technique to detect bony involvement. CT and MR imaging, when available, are the most accurate techniques for determining disease extension in both bones and soft tissues.

[Osteoarticular involvement in parasitic diseases: bone echinococcosis]. / Atteintes ostéo-articulaires d'origine parasitaire: l'échinococcose osseuse.

Hydatid disease is the most common human disease caused by helminths, but primary skeletal involvement is uncommon. Diagnosis is usually obtained late after considerable extension, half of which concerns the spine. The dissemination mode leads to local malignancy with severe prognosis. Medical imaging is essential. Plain x-ray findings are polymorphous and nonspecific, but computed tomography and magnetic resonance imaging are particularly useful for exhaustive pretherapeutic assessment of extension and for patient follow-up.

[Osteoarticular involvement in parasitic diseases: bone treponematosis]. / Atteintes ostéo-articulaires d'origine parasitaire: les tréponématoses osseuses.

Bone and joint localizations of treponematosis vary greatly although there are many common features. Osteal and periosteal lesions are common. We report radiographic descriptions of bone and joint treponematosis, which must not go unrecognized due to the increasing incidence of these diseases.

[Ileocolic intussusception in adults. Apropos of a case caused by benign inflammatory polyp of the terminal ileum]. / Invagination iléo-colique de l'adulte. A propos d'un cas, secondaire à un polype inflammatoire bénin de l'iléon terminal.

A case of an adult intussusception secondary to a fibroid polyp of the terminal ileum is reported. Adult intussusceptions are observed rarely, usually caused by an organic lesion. The preoperative diagnosis is based on US patterns, target aspect and sandwich sign.

[Rupture of the patellar ligament one month after treatment with fluoroquinolone]. / Rupture du ligament patellaire un mois après traitement par fluoroquinolone.

Musculoskeletal disorders including arthralgia and myalgia are adverse effect common to all fluoroquinolones. We report a case of spontaneous rupture of the patellar ligament in a 37-year-old man participating in leisure sports which occurred one month after a three-week course of Ciprofloxacine(R). Several cases of tendon ruptures have been reported in the literature, including the patellar tendon. Unusual features in our case were the one-month delay before tendon rupture and the absence of inaugural signs. We reviewed the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discussed proper management. Care must be taken when prescribing fluoroquinolones for patients at risk. Close follow-up is most important.

[Kudo non-constrained elbow prosthesis for inflammatory and hemophilic joint disease: analysis in 30 cases]. / Prothèse de coude non contrainte de Kudo dans l'arthropathie inflammatoire et hémophilique: analyse de 30 cas.

PURPOSE OF THE STUDY: We analyzed retrospectively 30 Kudo non-constrained elbow prostheses to determine: 1) functional outcome and mobility, 2) frequency of loosening and any complications. MATERIAL AND METHODS: From 1992 to 1998, 30 Kudo total elbow arthroplasties were performed in 29 patients, mean age 55 years. Mean follow-up was 36 months. These patients had severe joint disease: rheumatoid arthritis for 24, psoriatic arthritis for 2, and hemophilic arthritis for 3. The 29 patients experienced severe pain before surgery. RESULTS: At review, 21 elbows were pain free and the 9 others had only occasional pain. Among these 9 elbows, 3 exhibited a rupture of the humeral implant; one had already been revised but remained painful. One patient had a stiff painful elbow after reflex dystrophy and five others had pain but no other complication. Twenty-six patients were satisfied or very satisfied. Three patients were unsatisfied because of the humeral implant fracture. Mean mobility at last follow-up was: 128 degrees flexion, -35 degrees extension, 72 degrees pronation, and 74 degrees supination. Mean gain in flexion-extension was 15 degrees and mean gain in pronosupination was 3 degrees. Pronosupination was greater than 100 degrees except for two patients. There was one immediate post-operative dislocation with failure of prolonged orthopedic treatment after reduction; this patient underwent revision reconstruction with repair of the ulnar collateral ligaments (plasty of the medial collateral ligament with a synthetic ligament). Painful movement of the radial stump was observed with one Kudo prosthesis and required resection to achieve cure. In all, there were 3 fractures of the Kudo I prosthesis at the junction of the trochlea and the humeral stem. Among these patients, one underwent revision due to persistent pain, and two others with currently acceptable symptoms are awaiting revision. At last follow-up, we had: 1 ulnar loosening associated with cortical thinning facing the end of the ulnar implant that had migrated and showed a circular lucent line measuring > 1 mm and progressing; 9 unique ulnar lucent lines measuring<1 mm without progression at the proximal part of the implant (6 at the bone-cement interface and 3 at the bone-implant interface); 3 humeral radiolucent lines (<1 mm without progression) on the distal part of the Kudo II humeral stems corresponding to a zone without surfacing. We also observed 13 cases of incomplete ossification between the humerus and ulna and among these 13, 7 elbows had amplitudes of less than 100 degrees. DISCUSSION AND CONCLUSION: Elbow arthroplasty can restore a painless joint and maintain or improve elbow motion. The procedure is indicated when the joint disease impair daily life activities. Final mobility basically depends on the preoperative mobility. The bone stock remains the greatest problem with these resurfaced prostheses. The GUEPAR elbow prosthesis would appear to be more adapted due to the reconstruction of the trochlea. Resection of the radial head is a source of instability for elbow prostheses and should lead to the design of three-compartment prostheses.

[Senegal: installation of a microcomputer in the emergency admission service of the Ziguinchor Regional Hospital]. / Senegal: mise en place d'un micro ordinateur dans le service d'accueil des Urgences de l'Hopital Regional de Ziguinchor.

An Emergency Department was opened at the Regional Hospital of Ziguinchor in August 1993. Although adapted to local conditions, facilities are state-of-the-art and allow 24-hour reception of patients regardless of the gravity of their condition. There are many people involved: family, police, firemen, administration ... and there are also many questions. Records must be efficiently and accurately managed and the computer is the ideal tool for this purpose. The department was able to install a system at a particularly low cost since the PC computer and Epi-Info software were provided at no charge by the World Health Organization. To ensure consistent data entry, a coding system was used with some codes being specific to the department. Thanks to this system the department now has a 24 hour source of information for day-to-day management, statistical reporting, regional morbidity assessment, comparison of performance with similar facilities, and patient follow-up. Our experience shows that this type of low-cost computer system and simple processing techniques are perfectly suited to the special requirements of medical practice in Black Africa.

[Cost effectiveness of local regional anesthesia in a remote area]. / Intérêt économique des anesthésies loco-régionales en zone deshéritée.

Loco-regional anesthesia techniques are considered as a simple and economic solution to problems posed by anesthesia in developing countries. However the cost benefits of some techniques are reduced by cardiovascular effects that affect the quantity and nature of peroperative vascular filling usually necessary during general anesthesia. The purpose of the present study was to ascertain the relative costs of these methods by comparing the quantity of crystalloid solution and blood administered during loco-regional anesthesias and general anesthesias in a general hospital center in Africa. In a retrospective cohort of 1050 consecutive patients operated on in the Surgery and Gynecology/Obstetrics Departments of the A. Sice Hospital in Pointe Noire (Congo), 495 included in a study comparing perimedullary anesthesia and general anesthesia. The total volume of solution and blood administered to the patients during the procedure was studied in function of the type of anesthesia and surgery performed. Results showed that the amount of crystalloid solution administered during peridural and spinal anesthesia tended to be higher. This difference was significant only for prostate surgery. Use of epidural anesthesia did not increase the quantity of fluid modified gelatin and blood transfused in this series. It was also observed that 55% of patients who underwent peridural anesthesia required further intravenous anesthesia as opposed to 18.8% of patients who underwent spinal anesthesia. These findings indicate that loco-regional anesthesia performed under standardized conditions does not significantly change the quantity and nature of preoperative filling usually necessary during general anesthesia. Thus these techniques can be considered as cost-effective in developing countries even though the long period necessary for practitioners to learn them results in a transient increase in cost. A prospective study by surgical groups with experience using loco-regional anesthesia is needed to confirm this study.

[A 36 month prospective study of 12 plate osteosyntheses of distal radius fractures]. / Etude prospective sur 36 mois de 12 ostéosynthèses en vasque de l'extrémité distale du radius.

INTRODUCTION: We performed a prospective study of 12 intra-articular distal radial fractures. The fractures were treated with an anterior plate together with posterior pinning. The aim of the study was to examine whether it was technically feasible to fix such fractures using this technique and to assess the stability of the fixation at follow up. METHOD: Twelve articular fractures were included with a mean age of 47.1 years. All patients were followed up from first admission to the 36th postop month with clinical and radiological checks. RESULTS: At follow up, we found 8 good and excellent clinical results, 3 fair and 1 poor. The combination of an anterior plate with posterior pinning allowed a good initial reduction but could not protect from secondary displacement particularly in the presence of a comminuted metaphysal fracture. DISCUSSION: This procedure gave clinically satisfactory results but did not control ulnar variance. This procedure should be combined with bone grafting in complex metaphysal fractures and epiphysal screws should be used whenever possible.

[Role of external fixators for treatment of humeral fractures: report of 23 cases using Orthofix fixators]. / Intérêt du fixateur externe dans le traitement des fractures de l'humérus: à propos de 23 fixateurs Orthofix.

From 1991 to 1998, 23 humeral fractures has been treated using the Orthofix external fixator. Average age of the patient was 42 y and average follow-up 55.5 m. Initial trauma was: 13 traffic accidents, four falls at home, two devastating farming accidents, two sports accidents, one aggression and one gun accident. AO classification was used and location of the fracture was classified using Hackethal classification modified by de la Caffinière. Majority of fractures were located at the one-third distal humerus and the majority was also comminuted. At follow-up, elbow range of motion was 130 degrees, shoulder range of motion 161 degrees, external rotation 69.5 degrees and internal rotation 92.5 degrees. Using the classification of Stewart and Hundley, eight excellent, seven good, three fair and two bad results were obtained. There were no postoperative radial nerve palsy. Two external fixators had to be removed because of pin mobility. Failures were: non union and pin mobility in one patient which has to be reoperated on; two non unions have been grafted on and plated. There were no malunion in the postoperative X-rays. This device is our favourite for this type of injury because of its rigidity and the possibility of secondary dynamization. The external fixator was removed after union: this explains the long delay of union in our series.

[Spinal anesthesia in Africa. Risks, precautions]. / La rachianesthésie en Afrique. Risques, précautions à prendre.

Practice of anaesthesia in Africa rural zones needs adaptation to its peculiarities: pathology abundance, equipment and skilled staff shortage, medical and surgical acts delegation. It is high risk anaesthesia to do in a perspective of public health. Spinal anaesthesia, simple and cheap, is the technique of choice used for 86% of operations in our hospital. However it may induce sympathetic tone abolishment with marked falls in blood pressure and even cardiac arrest. To suppress the part of chance in this high risk context, we have made repetitive sympathetic perturbations prophylaxis, thanks to 2 protocoles. One issued from "saddle-block" allows genital and below surgery. Main worry is to get sure sensitive level, below D10. We use hyperbare technique, so blood pressure falls are less than 5%. The other is for abdominal surgery. Main worry is hypotension prophylaxis and management. We use hypobare technique, which allows Trendelenburg position with low cost and low risk autotransfusion. Other measures to reduce incidence of hypotension include prophylactic administration of atropine, ephedrine, and oxygen during the installation of anaesthesia.

[Validation of the reproducibility of the DMF Index used in bucco-dental epidemiology and evaluation of its 2 clinical forms]. / Validation de la reproductibilité de l'indice CAO utilisé en épidémiologie bucco-dentaire et évaluation de ses deux formes cliniques.

The DMF index is the one most commonly used in oral epidemiology to quantify the extent of caries. It represents the total of untreated decayed, missing and filled teeth in a person's mouth. A review of the literature shows that while this index is internationally recognized by the scientific community and people engaged in clinical dental practice, information demonstrating its reproducibility is scanty. The initiation and promotion of studies on the validity of the DMF index depend on first evaluating its reproducibility. This evaluation is based on an analysis of the rate of concordance between the results observed when a sample of subjects is examined twice, either by the same examiner or by two examiners at different times. Three types of comparison were carried out as part of this presentation: comparisons of results by one examiner, between two examiners, and between the two clinical forms of the DMF index according to whether it is calculated by tooth (DMFT) or tooth surface (DMFS). Each of the comparisons covered a group of 50 or so adult subjects selected solely for having an adequate number of teeth presenting different conditions. In all 215 persons were examined twice, making up a total of over 21,000 characters recorded. The state of each of the 32 permanent teeth, or of their 148 surfaces for the DMFS index, was codified using a digit selected from the seven possibilities corresponding to the letters D, M, F, and S (tooth that has not developed, untreated decayed, extracted, filled, healthy, replaced by a fixed or removable prosthesis). The statistical analysis covered 5 variables: the number of decayed, missing, filled and healthy teeth and the DMF index, for the whole mouth and tooth by tooth. The main finding emerging from this study is that for each comparison the rates of concordance are very high, higher for the one-examiner comparisons (> 64%) than for the two-examiner comparisons (> 45%). Comparison between the two types of data-gathering shows rates of over 72% for all the variables. The correlation coefficients between the scores attributed in two successive examinations are all over 0.9, with very small variation intervals even when the rates of concordance are lower. In fact, the differences between the results are generally of the order of +/- 1 tooth. Except in two cases, the Student test (t test) is not significant, which indicates that the means of each of the 5 variables did not differ statistically from one observation to another.(ABSTRACT TRUNCATED AT 400 WORDS)

A trans STT, trans capitate perilunate dislocation of the carpus. A case report.

We report a case of carpal injury not previously described, associating three lesions of the carpus secondary to a hyperextension mechanism: fracture of the capitate, scapho-trapezio-trapezoid sprain and lunotriquetral ligament rupture. The patient was operated by percutaneous pinning after closed reduction. The capitate fracture was not fixed. At follow-up, the patient had no restriction of his everyday activities and was very satisfied.

Structure-activity analysis of the effects of lysophosphatidic acid on platelet aggregation.

Lysophosphatidic acid (1-acyl-sn-glycero-3-phosphate or LPA) is a phospholipid mediator displaying numerous and widespread biological activities and thought to act via G-protein-coupled receptors. Here we have studied the effects on human platelets of a number of LPA analogues, including two enantiomers of both N-palmitoyl-(L)-serine-3-phosphate ((L) and (D)NAPS for N-acyl-phosphoserine) and 2-(R)-N-palmitoyl-norleucinol-1-phosphate ((R) and (S)PNPA), cyclic analogues of 1-acyl-sn-glycero-3-phosphate (cPA) and of 1-O-hexadecyl-sn-glycero-3-phosphate (cAGP), sphingosine-1-phosphate (SPP), as well as two palmitoyl derivatives of dioxazaphosphocanes bearing either a P-H or a P-OH bond (DOXP-H and DOXP-OH, respectively). Nine of these compounds induced platelet aggregation with the following order of potency: SPP < cAGP < DOXP-OH < (L)NAPS = (D)NAPS < (R)PNPA = (S)PNPA < LPA < AGP, EC50 varying between 9.8 nM and 8.3 microM. Two of these compounds (SPP and cAGP) appeared as weak agonists inducing platelet aggregation to only 33% and 41%, respectively, of the maximal response attained with LPA and other analogues. In cross-desensitization experiments, all of these compounds specifically inhibited LPA-induced aggregation, suggesting that they were all acting on the same receptor(s). In contrast, cPA and DOXP-H did not trigger platelet aggregation but instead specifically inhibited the effects of LPA in a concentration-dependent manner. The inhibitory action of cPA did not vary with the acyl chain length or the presence of a double bond and did not involve an increase in cAMP. These data thus confirm the lack of stereospecificity of platelet LPA receptor(s). In addition, since the order of potency of some analogues is different from that described in other cells, our results suggest that platelets contain (a) pharmacologically distinct receptor(s) whose molecular identity still remains to be established. Finally, this unique series of compounds might be used for further characterization of other endogenous or recombinant LPA receptors.