Irreducible posterolateral elbow dislocation: A case report.

Elbow dislocations are very common, particularly in the posterolateral variety. Closed reduction is usually easy. However, an irreducible elbow dislocation without associated fracture is rare. We report the case of a 21-year-old patient who presented with an isolated posterolateral irreducible elbow dislocation. Open reduction revealed the buttonhole radial head in the capsule and the complex ligaments. A significant protrusion of the radial head associated with a closed reduction failure is highly suspicious of an irreducible dislocation.

[Performance of magnetic resonance imaging ang genourob laximetry in anterior cruciate ligament rupture in 30 cases]. / Performance de l'imagerie par resonance magnetique et de la laximetrie a genourob dans les ruptures du ligament croise anterieur a propos de 30 cas.

INTRODUCTION: The aim of this work was to evaluate the diagnostic contribution of magnetic resonance imaging and genourob compared to intraoperative arthroscopy. The objective was to implement a protocol based on magnetic resonance imaging and / or genourob. MATERIALS AND METHODS: We did a cross-sectional study from July 18, 2016 to July 19, 2017 at the Maltese hospital comparing the results of MRI and GNRB from 30 patients compared to intraoperative arthroscopy data. RESULTS: Complete break.- In MRI, we obtained a sensitivity (Se) of 95.7%, a specificity (Sp) of 85.7%.- At the GNRB, we found a Se of 87%, a Sp of 42.9%.Partially broken.- In MRI we obtained a Se of 85.7%, a Sp of 95.7%.- At the GNRB, we found a Se of 42.9%, a Sp of 87%. CONCLUSION: MRI is better than GNRB. The GNRB does not improve the results of the MRI. It has no diagnostic contribution in the rupture of the ACL knee. It is a device used by the orthopedists to evaluate knee laxity that does not depend on the ACL alone.

INTRODUCTION: Le but de ce travail était d'évaluer l'apport diagnostique de l'imagerie par résonance magnétique (IRM) et du genourob (GNRB) par rapport à l'arthroscopie per opératoire. L'objectif était de mettre en place un protocole basé sur l'IRM et / ou le GNRB. MATÉRIELS ET MÉTHODES: Nous avons fait une étude transversale allant du 18 Juillet 2016 au 19 juillet 2017au centre hospitalier de l'ordre de malte en comparant les résultats d'IRM et du GNRB de 30 patients par rapport aux données de l'arthroscopie per opératoire. RÉSULTATS: ✓ Rupture complète.- En IRM, nous avons obtenu une sensibilité (Se) de 95,7 %, une spécificité(Sp) de 85,7%.- Au GNRB, nous avons trouvé une Se de 87 %, une Sp de 42,9%.✓ Rupture partielle.- En IRM, nous avons obtenu une Se de 85,7 %, une Spde 95,7%.- Au GNRB, nous avons trouvé uneSe de 42,9 %, une Sp de 87%. CONCLUSION: L'IRM est plus performante que le GNRB. Le GNRB ne permet pas d'améliorer les résultats de l'IRM. Il n'a pas d'apport diagnostique dans la rupture du LCA du genou. C'est un dispositif utilisé par les orthopédistes pour évaluer une laxité du genou qui ne dépend pas du LCA à lui seul.

[Recidives of Mycetoma after Amputation in Dakar (Senegal)]. / Récidives de mycétome après amputation à Dakar (Sénégal).

The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.

La chirurgie constitue le temps essentiel du traitement des mycétomes fongiques. Elle consiste en une amputation en cas d'atteinte osseuse. Nous avons observé 5 cas de récidives après amputation pour mycétome. Il s'agit dans tous les cas de patients présentant des mycétomes à grain noir avec atteintes osseuses. Les récidives sont survenues à moins de 18 mois de l'amputation faisant parler de reprise évolutive et posant le problème du niveau de l'amputation.

[Pulmonary Metastase of a Knee Mycetoma in Senegal]. / Métastase pulmonaire d'un mycétome du genou au Sénégal.

Mycetoma is transmitted by thorns infected. The commonest site for mycetoma is the foot. The primary pulmonary are rare and usually secondary to other primary site. We report a case of pulmonary fungal mycetoma secondary to primary site in the knee. We do a review of the literature and we discuss the way of dissemination.

Le mycétome se transmet principalement par piqures d'épines d'arbustes infectés. Les localisations primitives au niveau du pied sont les plus fréquentes. Les localisations pulmonaires sont exceptionnelles et secondaires à des localisations périphériques primitives. Nous rapportons un cas de localisation pulmonaire d'un mycétome fongique secondaire à une localisation au niveau du genou, puis nous faisons une revue de la littérature et nous discutons de la voie de dissémination.

Surgical Treatment of Angular Pott's Kyphosis with Posterior Approach, Pedicular Wedge Osteotomy and Canal Widening.

BACKGROUND: It has been observed that the correction of severe posttuberculous angular kyphosis is still a challenge, mainly because of the neurologic risk. METHODS: Nine patients were reviewed after surgery (mean follow-up 18 months). There were 2 thoracic, 4 thoraco-lumbar and 3 lumbar kyphosis. The mean age at surgery was 23. Clinical results were evaluated by the Oswestry Disability Index (ODI) and by the neurologic evaluation. Preoperative, postoperative and final follow-up X-rays were assessed. The surgery included a posterior approach with cord release and correction by transpedicular wedge osteotomy and widening of the spinal canal. RESULTS: Average kyphotic angulation was 72° before surgery, 10° after surgery and 12° at follow-up. Three out of four patients with neural deficit showed improvement. Neurologic complications included a transitory quadriceps paralysis, likely by foraminal compression of the root. CONCLUSION: A posterior transpedicular wedge osteotomy allows a substantial correction of the kyphosis, more by deflexion than by elongation, with limited neurologic risks. However it is mandatory to widely enlarge the spinal canal on the levels adjacent to the osteotomy, in order to allow the dura to expand backwards.

Identification of the first eubacterial endonuclease coded by an intein allele in the pps1 gene of mycobacteria.

A survey of a vast range of mycobacterial strains led us to discover a new Pps1 intein allele in Mycobacterium gastri which differs from those of Mycobacterium tuberculosis and Mycobacterium leprae in both its sequence and insertion site. While little is known about Pps1, except that it belongs to the YC24 family of ABC transporters, we show that, unlike the other inteins described so far from Eubacteria, the MgaPps1 intein possesses a specific endonuclease activity. The intein is the first eubacterial intein to be characterised as an endonuclease. Like other intein endonucleases, its minimal sequence for recognition and cleavage is quite large, with 22 bp spanning the Pps1-c site. The fact that an active endonuclease is found among the mycobacterial inteins supports the concept of a cyclical model of invasion by horizontal transfer of these genes, followed by degeneration and loss until a new invasion event, thus explaining their long-term persistence in closely related eubacterial species.

Induction of polyploid nuclei in the plasmodium of Physarum polycephalum by platinum antitumor compounds.

The intranuclear mitosis of the plasmodial nuclei of myxomycetes permits the observation of defects in chromosomal repartition which would probably be lethal in other eukaryotic cells with open mitosis. We found that antitumoral platinum-amine compounds perturbed late mitotic events and induced the formation of giant nuclei which were polyploid in plasmodia of Physarum polycephalum. Using 26 platinum-amine complexes, we have shown that all antitumoral compounds induced the formation of polyploid nuclei for drug concentrations at least three times lower than the amount necessary to block the overall plasmodial growth, whereas platinum compounds without antitumor activity did not behave this way. DNA replication appeared to be quantitatively normal during formation of giant nuclei by antitumoral compounds. These observations suggest that platinum-amine compounds exert their antitumor activity by interfering with mitosis rather than by a gross inhibition of DNA synthesis.

Modified Dunn osteotomy using an anterior approach used to treat 26 cases of SCFE.

INTRODUCTION: Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. HYPOTHESES: Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? MATERIAL AND METHODS: This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. RESULTS: The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. DISCUSSION: The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. LEVEL OF PROOF: IV, retrospective treatment study.

Interactions between Mycobacterium tuberculosis and host cells: are mycobacterial sugars the key?

Mycobacterium tuberculosis has evolved successful strategies to invade and persist within macrophages. Intimate pathogen-macrophage contacts dictate receptor choice and probably specify the intracellular fate of these microorganisms. Binding to specific receptors, such as complement receptor type 3, could provide an advantage. These interactions appear to involve surface polysaccharides and glycolipids.

Further specific triglycosyl phenol phthiocerol diester from Mycobacterium tuberculosis.

Mono- and two-dimensional 1H-NMR allowed the structural elucidation of a glycolipid belonging to the phenolic mycosides series: 2,3,4-tri-0-methyl fucopyranosyl (alpha 1----3) rhamnopyranosyl (alpha 1----3) rhamnopyranosyl (alpha 1----dimycocerosyl) phenol phthiocerol. It shares with the major phenolic glycolipid the two terminal sugar residues, suggesting its potential antigenicity. The glycolipid may also represent an intermediate in the biosynthesis of the major one.

Diglycosyl phenol phthiocerol diester of Mycobacterium leprae.

A diglycosyl phenol phthiocerol diester that had not been previously detected was isolated from M. leprae-infected armadillo tissues. Spectroscopy methods allowed the elucidation of its structure. The diglycoside was a 2,3-di-O-methylrhamnopyranosyl (alpha 1----2)3-O-methylrhamnopyranosyl (alpha 1-linked to the phenolic hydroxyl of phthiocerol dimycocerosates). It differs from the major phenolic glycolipid (PGL I) only by the absence of the terminal 3,6-di-O-methylglucopyranosyl unit. The diglycoside could be an intermediate in the synthesis of the latter antigen or a degradative product in the host detoxification process.

Structural elucidation by field desorption and electron-impact mass spectrometry of the C-mycosides isolated from Mycobacterium smegmatis.

C-mycosides are superficial type-specific glycopeptidolipids of mycobacterial origin. In the present work, we have shown that field desorption mass spectrometry using the cationization method is a useful method for the molecular weight determination of such compounds. Complementary structural information has been obtained by electron-impact mass spectrometry. Combination of both methods has permitted the elucidation of the structure of the C-mycosides of Mycobacterium smegmatis, ATCC 607. This structure is similar to those described elsewhere, but some minor differences are observed in the lipid portion, mainly in the double bond location.

Composition and phase behaviour of polar lipids isolated from Spirulina maxima cells grown in a perdeuterated medium.

The lipid composition of Spirulina maxima cells grown in a perdeuterated medium was determined by using nuclear magnetic resonance spectroscopy, fast atom-bombardment-mass spectrometry, gas chromatography-mass spectrometry as well as conventional chemical methods. The extent of deuteration was determined by mass spectrometry and was superior to 97.5%. The major lipids identified in the strain were: non-polar lipids (9%), monogalactosyldiacylglycerol (5%), digalactosyldiacylglycerol (22%), phosphatidylglycerol (31%), sulfoquinovosyldiacylglycerol (32%), phosphatidylinositol (traces). The major fatty acids were 16:0 (80%) and 18:1 (15%). These results demonstrate that the adaptation of the cells to D2O did not imply a profound modification of the lipid composition. The perdeuterated polar lipid mixture dispersed into an excess of water organises spontaneously in a lamellar phase as seen by 31P and deuterium solid state NMR and can therefore be used to prepare perdeuterated model membranes with a well defined composition. Liposomes made using these lipids have a gel to liquid-crystalline phase transition in the range 15-27 degrees C and are in a fluid L alpha phase above this temperature.

Monoglycosyldiacylphenol-phthiocerol of Mycobacterium tuberculosis and Mycobacterium bovis.

The structure of a minor glycolipid of M. tuberculosis (strain Canetti) is shown to be 2-O-methyl-alpha-L-rhamnosyldiacylphenol-phthiocerol. A similar compound with non-methylated rhamnose as sugar moiety was also detected. In the course of this work, the structure of mycoside B from Mycobacterium bovis was reexamined, and was shown to be identical to that of the 2-O-methylrhamnosyldiacylphenol-phthiocerol of the Canetti strain, while it was described as a 2-O-methyl-beta-D-rhamnosyl derivative in the literature. This result is in agreement with the known close relationship between M. tuberculosis and M. bovis. Careful examination of chromatographic fractions containing the above mentioned lipids showed that the occurrence of mycoloyl residues in some phenol-phthiocerol glycolipids, postulated in the literature, was likely to be due to the presence of glycerol monomycolate contaminants.

The envelope layers of mycobacteria with reference to their pathogenicity.

The review discusses current knowledge of the biosynthesis, composition and arrangement of the mycobacterial envelope, describes the biological activities of the constituents and considers how these activities may be relevant to the pathology of mycobacterial disease. The envelope possesses three structural components: plasma membrane, wall and capsule. Although the major biomolecules occurring in each of these parts are known, the distribution of numerous minor substances is poorly understood; an attempt has been made to assign them to particular positions on rational grounds. The plasma membrane appears to be a typical bacterial membrane but, though vital to the mycobacterium, probably plays little part in pathological processes. The wall partly resembles a Gram-positive wall, but is unusual in having a layer of lipid (mycolate esters) which is probably arranged to form a permeability barrier to polar molecules. The capsule, whose chemical composition has only recently been recognized, consists of polysaccharide and protein with traces of lipid; the arrangement of these components is imperfectly understood. Constituents of all parts of the envelope have biological activities which may be relevant. The likely importance of these activities in the overall effect of the envelope is considered.

Inteins invading mycobacterial RecA proteins.

Five new inteins were discovered in a survey of 39 mycobacterial strains that was undertaken to clarify the role of RecA inteins in mycobacteria. They are all inserted at the RecA-b site of the recA gene of Mycobacterium chitae, 4. fallax, M. gastri, M. shimodei and M. thermoresistibile and belong to the MleRecA allelic family. Sequence analysis showed that although only M. tuberculosis harbours an intein at the RecA-a site the sequence of the RecA-b site is well conserved between species. Furthermore, the presence of inteins does not correlate with specific characteristics of the species such as pathogenicity or growth rate.

Distribution of GyrA intein in non-tuberculous mycobacteria and genomic heterogeneity of Mycobacterium gastri.

To gain further insights into the understanding of the intein invasion process in mycobacteria, intein sequences in the gyrA gene of 42 mycobacterial strains were searched and a new gyrA intein was found in Mycobacterium gastri (Mga). This 1260 bp intein, named MgaGyrA, inserted at the GyrA-a site, is highly homologous to the members of the Mycobacterium leprae GyrA allelic family. As the recA intein, MgaGyrA was detected in only one out of six Mga strains examined, while the pps1 intein was a constant character of Mga. This data supports the genomic heterogeneity of Mga towards intein invasion, a finding that may have phylogenetic implications.

Interaction of mycobacterial glycolipids with host cells.

Mycobacteria elaborate a great variety of glycolipids of rather exotic structure. Some of these lipids are abundant cell envelope components and are exposed on the bacterial surface. These comprise the species-specific phenolic glycolipids, glycopeptidolipids, sulfatides, and lipooligosaccharides, and the ubiquitous phosphatidylinositolmannosides. Because pathogenic mycobacterial species are facultative intracellular parasites that infect and reside in host cells, some of them may represent potential virulent factors as they have been shown to inhibit both macrophage antimicrobial activities and lymphoproliferation. These biologic activities may derive, at least in part, from the modulation of the cell functions through the interactions between host membranes and these surface-exposed lipids whose structures are different from those of mammalian cell membrane components. In few cases purified glycolipids have been shown to profoundly affect the physical and functional properties of biologic membranes. Therefore, the enzymes involved in the biosynthesis of the biologically active glycolipids represent potential drug targets. However, definite proofs of their implication in the mycobacterial pathogenicity are lacking. Mutants unable to elaborate defined glycolipids are needed.

Fast atom bombardment mass spectrometry of Mycobacterial glycopeptidolipid antigens: Structural characterization by charge remote fragmentation.

Mycobacteria contain species- and type-specific antigens. Among them, glycopeptidolipids are present in medically relevant organisms belonging to Mycobacterium avium or M. fortuitum complexes. Fast-a tom bombardment mass spectrometry of glycopeptidolipids has proven to be difficult. In this article the cationization method with a metanitrobenzyl alcohol matrix, doped with sodium iodide, is described for analyzing these molecules. The molecular weight of the intact glycopeptidolipids was successfully determined and, using mass-analyzed ion kinetic energy spectrometry, the complete sequences of the peptide and saccharide moieties were elucidated. Moreover, the two structural variants present in these molecules were clearly differentiated. Application of the method showed that the same structural variant occurs in the glycopeptidolipids from two serologically related species of the M. fortuitum complex.

Further stereochemical studies of phthiocerol and phenol phthiocerol in mycobacteria.

Mycobacterium tuberculosis, M. marinum and some other pathogenic species elaborate waxes A, based on a long-chain beta-diol (phthiocerol and companion compounds) and polymethyl-branched fatty acids. The stereochemical studies conducted on waxes A showed that those of M. tuberculosis, M. leprae and M. kansasii differ from waxes A isolated from M. marinum and M. ulcerans by the absolute configuration of the methyl-branched chiral centres occurring in both the long-chain beta-diols and the fatty acyls. Furthermore, the two mycobacterial groups also differ in the stereochemistry of the beta-diol chiral centres.