[Treatment of sequelae of burns in children]. / Le traitement des séquelles de brûlure de l'enfant.

Burn sequelae in children are conveyed in the form of retraction, deformity and growth problems together with dyschromia and trophic disorders. All the plastic surgical procedures can be used to correct them: full thickness or split thickness skin grafts, Z plasty and its derivatives (trident plasty, IC flaps), expansion, flaps, artificial skin, and dermabrasion. In most cases, these procedures will be combined. The aim of surgical treatment coordinated with rehabilitation is to restore the function, correct the deformities induced, improve the morphological aspect and permit normal growth. Good knowledge of the paediatric environment is, however, required to cope with the specificities of the child: treat the severe local inflammation, get the family to participate in the projects of rehabilitation, sometimes with the help of social services, maintain normal schooling, accompany the disorders in body schema, and, finally, prolong follow-up until growth is complete, a challenge in these patients who are often very young at the time of the accident.

[History of skin graft]. / Une histoire de peau.

Skin graft is the most common and simple procedure to cover superficial defect. Skin of variable thickness and size is completely detached from its origin (donor site) to cover a defect (recipient site). This simple procedure is the result of a long and eventful technical and theoretical evolvement. The aim of this article is to re-trace the history of skin grafting, from its discovery until today.

[Cervical congenital hemangioma: diagnosis and management difficulties]. / Hémangiome cervical congénital: difficultés de diagnostic et de prise en charge.

Rapidly involuting congenital haemangioma (RICH) is a rare vascular tumour whose antenatal diagnosis is difficult. During ultrasound examination at 32nd weeks' gestation, a voluminous heterogeneous cephalic lesion was discovered that could be a haemangioma or a teratoma. A caesarean delivery was performed. The tumour was removed directly after birth. The pathology examination concluded on a RICH. Antenatal, prepartum and postnatal management are not consensual and must consider the lesion size.

[Nipple-areola complex reconstruction with full-thickness skin graft and subcutaneous pedicled island flap]. / Reconstruction de la plaque aréolomamelonnaire par un lambeau à pédicule sous-cutané associé à une greffe de peau totale.

We are reporting on an easy, reliable and reproducible nipple-areola complex reconstruction. The main feature is to perform a full-thickness skin graft to rebuild the areola and a subcutaneous pedicled island flap for the reconstruction of the nipple in the middle of the graft. Each step is described. This technique remains easily practical and allows to keep an appropriate nipple projection. Moreover, it fits to all kind of breast reconstruction.

[Long-term morphologic results of a 32 successive patients series presenting unilateral complete cleft lip and palate with surgery at early age]. / Résultats morphologiques à long terme d'une série de 32 patients successifs porteurs de fentes labiopalatines unilatérales totales opérées en conditions précoces.

STUDY OBJECTIVE: The aim of this retrospective study is to describe and evaluate the long term morphologic results of patients who present unilateral complete cleft lip and palate. PATIENTS AND METHODS: Thirty-two patients with non syndromic unilateral complete cleft lip and palate were operated early by the same surgeon, at the mean age of 70,4 days old, with two operating procedures. The first group was operated of cheiloplasty with the Millard method during the neonatal period, associated to the closure of the palate in the same time. The second group was operated with a modified Millard method during the neonatal period associated to a closing of the palate by the Wardill method at the age of ten months old. The criteria of evaluation were the anatomic remaining abnormalities after surgery of nose, lips, primary and secondary palate (back of 17 years). RESULTS: Our results show that Millard method and derived are taken as a whole effective, even if the number of secondary surgery and supplementary adjustments was sizeable (87%). The postoperative abnormalities concerning red lip (discontinuity, mucous excess) were frequent (53%), but easily correctable. The secondary surgeries were mainly for minor touch up of lip (46%), second time palate surgeries (53%), and rhinoplasties (40%). CONCLUSION: Progress in anesthesia and reanimation allowed us to assure an early management of clefts. The absence of incorrigible after-effects by a secondary surgery of the first-operated patients encouraged the team to continue in this way.

[Beyond the diagnosis of a genetic disease, the question of informing the relatives]. / Au-delà du diagnostic d'une maladie génétique, la question de l'information de la parentèle.

The examination of a person's genetic characteristics is not a classic diagnostic. It concerns the gene pool of an entire family. It is valid in the present and may affect some part of the future. The diseases that it reveals, sometime very serious ones, may or may not be treated. But genetic advice allows sometimes to preventing some of these diseases. The 2004 Bioethics Law makes the provision that in case a serious genetic anomaly is diagnosed during the examination of a person's genetic characteristics, the medical doctor informs the person or its legal representative of the risks that his silence could cause to the potentially concerned family members as long as prevention measures or care can be offered to them. For these reasons, besides the specificity of the diagnostic for the person directly concerned, there is also the question of the right of other people, like family members, to be informed of the diagnostic. As such, there is an ethical conflict between medical confidentiality owed to each patient and the duty of information. The pharmacist must know the medical confidentiality rules that frame this information. He must also know the different patient attitudes and must be able to encourage him to inform his family because the future if not the life of others may depend on this information.

Frequency and socio-psychological impact of taunting in school-age patients with cleft lip-palate surgical repair.

OBJECTIVES: Cleft lip-palate (CLP) is a "social" pathology because of its impact on the child's facial appearance and speech. School is the first place where children are confronted to others and when they start socializing. Taunting and bullying are common and their psychological impact remains hard to assess. The aim of this study was to evaluate the importance of taunting in school and its impact in CLP patients who had surgical repair. METHODS: We conducted a multicenter prospective study where we consecutively included patients ≥ 12 years who had CLP repair. During a multidisciplinary consultation they were asked to complete a questionnaire (3 parts: surgical outcomes, taunting and its impact, socio-economic status) previously approved by our psychologists. RESULTS: 55 patients were included (37 B, 18 G) (mean age 15.5 years): 11 CL, 13 CP and 31 CLP. 69% of patients reported having suffered from taunting and peer victimization in school. In 84% of the cases, taunting was linked to the CLP defect itself. The teasing started in primary school to reach a peak of aggressiveness in middle school. 42% of patients reported that bullying occurred at least once a day (16/38). Regarding the psychological impact of taunting, 50% of patients reported sadness, 31% depression and 26.3% were marked for life. At one time or another 29% of patients did not want to attend school because of the teasing. The grade retention rate amounted to 37.7% (20/53), and 2 patients were in special education classes. As a matter of fact, 50% of these children repeated their 1st or 2nd year of primary school. Furthermore, 47% of patients wanted to change something to their face, but 63% of them never spoke to their surgeon about additional surgeries even though they were teased in school. CONCLUSIONS: Taunting is common in children with CLP. This study highlights the high frequency and impact of taunting on the daily lives and self-perception of patients with CLP or CLP repair. It is important for healthcare professionals to be aware of this issue in the context of a multidisciplinary approach.

Involvement of pectin methyl-esterase during the ripening of grape berries: partial cDNA isolation, transcript expression and changes in the degree of methyl-esterification of cell wall pectins.

Grape berries (Vitis vinifera L., cv Ugni blanc) were harvested at 12 different weeks of development in 1996 and 1997. Ripening was induced at veraison, the crucial stage of berry softening, and was followed by a rapid accumulation of glucose and fructose and an increase of pH. Total RNAs, crude proteins and cell wall material were isolated from each developmental stage. A partial length cDNA (pme1, accession number AF159122, GenBank) encoding a pectin methyl-esterase (PME, EC 3.1.1.11) was cloned by RT-PCR with degenerate primers. Northern blots revealed that mRNAs coding for PME accumulate from one week before the onset of ripening until complete maturity, indicating that this transcript represents an early marker of veraison and could be involved in berry softening. However, PME activity was detected during all developmental stages. Total activity per berry increased, whereas "specific" activity, on a fresh weight basis, decreased during development. The amount of cell wall material (per berry and per g of berry) followed the same pattern as that of PME activity (total and "specific" respectively), indicating they were tightly correlated and that PME levels varied very little in the cell walls. Nevertheless, the degree of methyl-esterification of insoluble pectins decreased throughout the development from 68% in green stages to less than 20% for the ripe berries, and this observation is consistent with the induction of PME mRNAs during ripening. Relations between transcript expression, PME activity, the DE of insoluble pectic polysaccharides and their involvement in grape berry ripening are discussed.

Anterior approach and osteosynthesis for recent fractures of the pedicles of the axis.

The authors report their experiences using the anterior approach and osteosynthesis for recent fractures of the pedicles of the axis in eight patients. They describe the transcervical transclival approach and osteosynthesis and discuss the advantages of and indications for this approach.

Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas.

Seven cases of frontotemporosphenoid meningioma are reported. The principles of the orbitofrontomalar approach and of reconstruction of the orbital cone and of the frontomalar region with an orbitotemporal prop are discussed.

Purification and properties of an exo-(1-->3)-beta-D-galactanase from Aspergillus niger.

An exo-(1-->3)-beta-D-galactanase was purified by six chromatographic steps from a culture supernatant of Aspergillus niger. Its apparent molecular mass was 66 kDa, as estimated by SDS-PAGE analysis. The purified enzyme had no detectable activity on various p-nitrophenyl glycosides and on native plant polysaccharides but exhibited a high activity on a (1-->3)-beta-D-linked galactan backbone obtained after partial acid hydrolysis and two Smith degradations of gum arabic. The optimum conditions were pH 4.5 and 40-50 degrees C. The enzyme had a Michaelis constant (Km) of 1.9 mg/mL for the beta-(1-->3)-D-galactan with a maximum reaction velocity (Vmax) of 1380 nkat/mg. The study of the reaction products obtained after enzyme treatment of two galactans derived from gum arabic through one or two Smith degradations showed that it was an exo-(1-->3)-beta-D-galactanase able to by-pass the branching points of galactan backbones and thus to release the side-chains of type II arabinogalactans in an undegraded form.

Rhamnogalacturonan II, a dominant polysaccharide in juices produced by enzymic liquefaction of fruits and vegetables.

Rhamnogalacturonan II (RG-II), a small complex pectic polysaccharide, is released from apple (Malus domestica), carrot (Daucus carota), and tomato (Solanum lycopersicum) by treatment with two commercial liquefying enzyme preparations. RG-II was isolated by size-exclusion chromatography from apple, tomato, and carrot juices obtained by enzymic liquefaction. All the RG-IIs contained the diagnostic sugars, apiose, 2-O-methyl-L-fucose, 2-O-methyl-D-xylose, aceric acid, Kdo and Dha. Glycosyl-linkage compositions of the neutral and acidic sugars, including aceric acid, were consistent with the hypothetical model described for sycamore RG-II confirming the conservation of RG-II in plants. Thus, when pectinolytic enzyme preparations are used to process fruits and vegetables, RG-II is released as a main soluble polysaccharide fraction while other pectic polysaccharides are heavily degraded.

Characterization of five type II arabinogalactan-protein fractions from red wine of increasing uronic acid content.

Five arabinogalactan-protein conjugates (AGP) were separated from red wine by two successive anion-exchange chromatography steps and further purified to apparent homogeneity by affinity and size-exclusion chromatography. Together they represent more than 40% of total wine polysaccharides, confirming the abundance of AGPs in red wine. The five purified fractions had a common arabinogalactan core with characteristics typical of wine type II AGPs, but differed mainly in their uronic acid content, as evidenced by differences in the strength of their binding to the anion-exchanger. Their uronic acid content and glycosidic linkage composition revealed that the three less acidic AGPs contained from 3 to 7% glucuronic acid, half in terminal non-reducing positions and half in terminal Rhap-(1-->4)-Glc pA-(1-->sequences. The two more acidic AGP-containing fractions contained both glucuronic (6.1 and 13.3%, respectively) and galacturonic (1.9 and 2.3%, respectively) acid in association with 2- and 2,4-linked rhamnose, indicating the presence of AG-rhamnogalacturonan fragments.

Structural characterization of red wine rhamnogalacturonan II.

The pectic polysaccharide rhamnogalacturonan II (RG-II), which accounts for approximately 20% of the ethanol-precipitable polysaccharides in red wine, has been isolated from wine polysaccharides by anion-exchange chromatography. Four fractions enriched with RG-II were obtained and the RG-II then purified to homogeneity by Concanavalin A affinity and size-exclusion chromatographies. The glycosyl-residue compositions of the four RG-IIs are similar; all the RG-IIs contain the monosaccharides (apiose, 2-O-methyl-L-fucose, 2-O-methyl-D-xylose, Kdo, Dha, and aceric acid) that are diagnostic of RG-II. The glycosyl-linkages of the neutral and acidic sugars, including aceric acid, were determined simultaneously by GC-EIMS analysis of the methylated alditol acetates generated from per-O-methylated and carboxyl-reduced RG-II. Two of the RG-IIs contain boron, most likely as a borate di-ester that cross-links two molecules of RG-II together to form a dimer. The dimer contains 3'- and 2,3,3'-linked apiosyl residues whereas the monomer contains only 3'-linked apiosyl residues which suggests that the borate di-ester is located on at least one of the apiosyl residues of RG-II. Although the wine RG-IIs all have similar structures they are not identical since they differ in the length and degree of methyl-esterification of the RG-II backbone and in the presence or absence of borate di-esters. Nevertheless, these studies show that the major structural features of wine and primary cell wall RG-II are conserved.

Structural characterization of the pectic polysaccharide rhamnogalacturonan II: evidence for the backbone location of the aceric acid-containing oligoglycosyl side chain.

Monomeric rhamnogalacturonan II (mRG-II) was isolated from red wine and the reducing-end galacturonic acid of the backbone converted to L-galactonic acid by treatment with NaBH4. The resulting product (mRG-II'ol) was treated with a cell-free extract from Penicillium daleae, a fungus that has been shown to produce RG-II-fragmenting glycanases. The enzymatically generated products were fractionated by size-exclusion and anion-exchange chromatographies and the quantitatively major oligosaccharide fraction isolated. This fraction contained structurally related oligosaccharides that differed only in the presence or absence of a single Kdo residue. The Kdo residue was removed by acid hydrolysis and the resulting oligosaccharide then characterized by 1- and 2D 1H NMR spectroscopy, ESMS, and by glycosyl-residue and glycosyl-linkage composition analyses. The results of these analyses provide evidence for the presence of at least two structurally related oligosaccharides in the ratio approximately 6:1. The backbone of these oligosaccharides is composed of five (1-->4)-linked alpha-D-GalpA residues and a (1-->3)-linked L-galactonate. The (1-->4)-linked GalpA residue adjacent to the terminal non-reducing GalpA residue of the backbone is substituted at O-2 with an apiosyl-containing side chain. Beta3-L-Araf-(1-->5)-beta-D-DhapA is likely to be linked to O-3 of the GalpA residue at the non-reducing end of the backbone in the quantitatively major oligosaccharide and to O-3 of a (1-->4)-linked GalpA residue in the backbone of the minor oligosaccharide. Furthermore, the results of our studies have shown that the enzymically generated aceryl acid-containing oligosaccharide contains an alpha-linked aceryl acid residue and a beta-linked galactosyl residue. Thus, the anomeric linkages of these residues in RG-II should be revised.

Acrylic reconstruction of an arthritic cervical spine using the transcervical-transclival approach.

We describe the use of a transcervical-transclival approach in the treatment of an ascending luxation of the odontoid by rheumatoid arthritis. We favor this approach and use of methylmethacrylate in this rare condition. Other applications of this route which gives access to the craniocervical junction are discussed.

Comparative study of split thickness skin grafts taken from the scalp and thigh in children.

We compared 29 split thickness skin grafts taken from the thigh (group I) and 37 taken from the scalp (group II). The study was prospective with a follow-up period of 1 year. The average age was 29 months. Included in group I were those children whose parents refused permission for their hair to be shaved and those with burns to the head. We compared ease of technique, percentage of graft accepted, quality of the graft and after-effects of the donor site. Acceptance of the graft was close to 100 per cent in both groups. Harvesting was more difficult from the scalp (P < 0.0001). The quality of the grafts was identical in both groups. After-effects at the donor site were absent in group II and evident in group I (P < 0.0001). There was no alopecia. The scalp represented a better donor site for split-thickness skin grafting than the thigh in the child.

Use of human keratinocytes cultured on fibrin glue in the treatment of burn wounds.

Keratinocytes isolated from a small skin biopsy and cultured according to the method of Rheinwald and Green (Cell 1975, 6: 331) are able to undergo rapid expansion in vitro and have been used successfully in the treatment of burn wounds. One of the inconveniences of this method involves the transfer of the epidermal sheet from the culture flask onto the wound bed. One way to facilitate this process is to use fibrin glue (Biocol) as a culture bed for the keratinocytes. Burns are then grafted by simply placing the sheet of fibrin glue and keratinocytes onto the wound bed. This process has been successful in two patients, permanently covering areas of 720 cm2 and 5342 cm2. The newly formed epidermis was fully differentiated and histologically normal after 1 year. The efficiency of this improved, faster procedure could lead to a new approach in the treatment of extensive burn wounds.

Pedicle musculocutaneous flap transplantation: prediction of final outcome by transcutaneous oxygen measurements in hyperbaric oxygen.

In pedicle musculocutaneous flaps, a local circulatory insufficiency with a total or subtotal ischemia may occur and jeopardize the result of the reconstructive surgery. Transcutaneous oxygen pressure (PtcO2) monitoring has been shown to reflect tissue perfusion and has been advocated to predict the final outcome of ischemic flaps. Unfortunately, under normal atmospheric conditions, this test is not sufficiently discriminative. We evaluate the effect of hyperbaric oxygen conditions on the efficiency of this test. Fifteen patients with pedicle musculocutaneous flap were evaluated by clinical examination and transcutaneous oxygen tension measurements. The final outcome was healing in 7 and failure in 8. In order to determine the predictive value of transcutaneous oxygen tension, measurements were done immediately after the surgical procedure. In ambient air, neither the absolute value of transcutaneous oxygen tension (2.6 +/- 3.6 versus 11.7 +/- 12.6 torr; N.S.) nor the difference or the ratio between the transcutaneous oxygen tension of the flap and the subclavicular reference shows any significant difference according to the outcome (failure or success). The same is true in normobaric oxygen. In hyperbaric oxygen, however, there is a significant difference in transcutaneous oxygen tension between the two groups (12 +/- 12 versus 378 +/- 385 torr; p < 0.01). A transcutaneous oxygen tension higher than 50 torr in hyperbaric oxygen (2.5 atm abs) is the best cutoff value to discriminate success from failure.