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Copyright of Revue Historique (0035-3264) is the property of Presses Universitaires de France and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Proverbs play important role in language. They give emotionality, expressiveness to the speech. They have certain pure linguistic features that must always be taken into account in order to distinguish them from ordinary sentences. This article highlights the study and the significance of proverbs, their usage in speech in English and Uzbek languages. The correct usage of these proverbs is also important, while translating any other work of art we should pay close attention to this point, and that is the reason of the study of the theme we have taken under discussion.

Purpose: There is no consensus on the utility of postoperative antibiotherapy in hand infections after surgical management. The aim of this study was to evaluate if the absence of postoperative antibiotic therapy was detrimental after surgical treatment., Methods: We included 287 patients operated on for a hand infection between January 2018 and October 2023. Preoperative or postoperative antibiotic prescription was collected for every patient. Patients cured for their infection with a single surgery were classified as "simple evolution", while patients requiring repetitive surgery or who had at least one complication directly linked to the initial infection (extension of infection or necrosis) were considered "complicated"., Results: From a total of 287 patients, we included 188 paronychia, 40 phlegmons, 47 abscesses and 12 superinfected wounds. The revision surgery rate was 9.4%, and the complication rate was 27.2%. One hundred and seventeen (40.8%) patients received preoperative antibiotic therapy from emergency physicians or general practitioners, among whom a complication rate of 31.6% was observed. The causal link did not reach the significance threshold for the whole group of patients (P=0.079). However, preoperative antibiotic use in phlegmon patients was directly correlated with the occurrence of at least one complication (P=0.032). In all, 82.9% of patients did not require postoperative antibiotic therapy, 95% of whom had an uncomplicated course., Conclusions: Preoperative probabilistic antibiotic therapy is an independent risk factor for complications, particularly if given at a collected stage. Antibiotics should not be routinely prescribed postoperatively in a correct debridement is performed. We recommend that antibiotics be used only in very specific cases (osteitis, arthritis, necrosis and/or high-risk patients)., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Purpose: Report the epidemiological and lesion aspects of hand bone fractures in children. Patients and method: We did a retrospective and descriptive study over a 10-year period. This study involved 222 children under the age of 16 with 261 fracture cases. The parameters studied were frequency, age, sex, mechanism, circumstances of fracture, consultation time, data from standard physical examination and x-ray of the hand, and associated lesions. Results: Hand bone fractures accounted for 6.4% of all fractures in children in our service. The average age of the children was 8.5 years with a standard deviation of 4. There was a male predominance with a sex ratio of 2. Domestic accidents led the way with 44.3% of cases. They were followed by playful accidents with 33.94% of cases. Receiving heavy objects and falling with hand reception were the most common mechanisms. 62.8% of patients consulted within the first 24 hours. All fractures were in the metacarpals and phalanxes with 31% and 69% of cases, respectively. Head and diaphysis fractures each accounted for 28.1% of cases followed by cervical fractures with 27.8%. Non-displaced fractures accounted for 65% of cases. Associated lesions were found in 10 patients. Conclusion: Hand bone fractures are quite common. They often interest the big child in the decoy of a domestic or playful accident, by crushing the hand or falling with reception on the hand. Fractures of the phalanxes are the most common while those of carp are absent. [ABSTRACT FROM AUTHOR]

Hydroxyapatite crystal deposition disease (HADD) of the hand and wrist is rare but can cause acute inflammatory syndromes that mimic infectious arthritis. These symptoms, which rapidly resolve with systemic anti-inflammatory drugs, are a source of diagnostic errors and inappropriate treatment. It is of crucial importance to make the diagnosis in order to avoid iatrogenic surgical management. The aim of this study was to determine the clinical and radiographic signs and the key features on which diagnosis depends. Treatment effectiveness and the course of the disease were also examined. Between 1992 and 2008, 12 patients consulted for an isolated acute local inflammatory syndrome of the hand or wrist, which was accompanied by a unique radiographic picture of calcific density. All patients were reassessed clinically and radiographically with a minimum follow-up of 2 years. All patients had presented with acute local inflammatory syndromes. Nine patients had edema and 8 had swelling and erythema. No patient had fever. The course was favorable in 11 patients and one patient required surgery. No patient had a recurrence at the mean final follow-up of 90 ± 64 months. The symptoms associated with hydroxyapatite crystal deposits suggest septic arthritis with acute joint inflammation. The radiological appearance is characteristic and corrects the diagnosis. Oral anti-inflammatory treatment gives more rapid spontaneous improvement, with complete and long-lasting resolution.

Digit loss might be due to traumatic injuries, congenital malformations and various diseases. Rehabilitation of finger amputations requires aesthetics and functional aspects. Due to limited resources in low income countries, some local professionals find it difficult to meet the patient´s needs. One of the methods of gaining total suspension is to don the residual finger with aesthetic silicone prosthesis. A 25-year-old female presented with multiple-digit amputations of both of her hands due to autoimmune disease. At first stage of the treatment; silicone prostheses of the loss fingers of both hands were planned. The impressions of the remaining fingers were taken to manufacture the silicone prostheses. The manufactured prostheses with total suspension improved patient´s social life. The patient´s residual fingers were fitted with the prostheses after which she was satisfied with the aesthetic aspects.

We report the case of a young patient of 24 years, motorcyclist, victim of road accident, causing a closed trauma of the right wrist, the examination on admission finds a swollen, painful hand without vascular-nervous disorders, or compartment syndrome, the patient benefited from a radiological assessment made of an x-ray of the hand, face and profile and 3/4 objectifying an extremely rare entity of dislocation of the bones of the hand. It is a carpometacarpal dislocation of the last four rays. In the operating room under loco-regional anesthesia, and pneumatic tourniquet at the root of the limb, the patient benefited from a reduction with carpo-metacarpal plugging, supplemented by a plaster that the patient kept for 6 weeks.

Enchondroma (EC) is a benign and cartilage-forming tumor that causes intramedullary lesions. Moreover, EC is the most common bone tumor in the phalanges and metacarpal bones of the hand, deforming the structure and causing pain and functional limitation. The management of this neoplasia is the surgical treatment and the approach that is well-accepted consists in the curettage followed by the void augmentation with biological or synthetic fillers. The results from surgery are usually good and the recurrence rate is low (2-15%). In this article we report a case of EC recurrence of the proximal phalanx of the fifth finger of the hand after curettage and grafting. The patient was treated with the amputation of the fifth ray according to the Tsuge technique, obtaining a satisfying clinical result.

This article focuses on two artists who take the hand – the origin of most gestures since the beginning of mankind - as the centre of their research and activity. Writer Jean-Loup Trassard seeks to reconstruct the time-honoured gestures initiated by Neolithic man and about to be forgotten, while visual artist Miquel Barcélo reintroduces the hand in contemporary art, his works being freely inspired by the hand prints of Palaeolithic cave artists. Both draw on the persistence and revival of very ancient primordial gestures, whose traces need to be resurrected. The prehistoric gestures they reconstruct raise fundamental questions about our humanity, at a time when contemporary art sees a withdrawal of the hand in favour of a so-called liberation of man via modern technology.

There are few gestures that contemporary humans make more frequently than looking at their hand to consult a high-tech phone. This gesture is partly the outcome of new technological development, and partly inscribed in the memory of ancient gestures, in practices in which the palm of the hand was examined. From the mid-nineteenth century, a revival of interest in the study of palmistry, between magic and science, anticipated the cinema. In chiromancy, the palm of the hand enabled access to past and future, while chirognomony saw in it a mirror which reflected man’s personality and gestures (inscribed in the folds of the skin – which had been used in the learning of ancient music, but also discussed by Eisenstein). This illustrates the assumption made by anthropologist Marcel Jousse, for whom human gestures represent a kind of corporeal thinking, by which man imagined and anticipated technical development. Cinema itself acknowledged the importance of this gesture, since it used the palm of the hand as a screen onto which images were projected, from the start of the twentieth century to the twenties. Therefore this article addresses the role of gestures in media archaeology.

Blast hands are not rare accidents in our service. They generally affect the young child and teenager. They are usually caused by the explosion of firecrackers and fireworks and occur with predilection during the Christmas and New Year. The lesions they cause often contrast with the playful nature of their uses. We report a series of 4 cases of hands of firecrackers traited in our service. All occured during the end of year festivities of the Gregorian calendar. The admission deadline was less than one hour and all were male. Management consisted of initial trimming and early rehabilitation. The lesions were mainly dilapidations of the first commissure and the loss of one or more phalanges and in one case a loss of the first 4 fingers of the hand resulting in late schooling and in one case a change of dominant hand. The hands of blast are accidents occurring with a certain periodicity. Awareness and legislation on the use and sale of firecrackers and other fireworks could significantly reduce the impact of these injuries on children. [ABSTRACT FROM AUTHOR]

Verrucous carcinoma is rare well-differentiated squamous cell carcinoma with very rare metastatic potentiel. Pappilomatosis carcinoides cutis (PPC) is the rarest form of verrucous carcinoma. The risk factors for PCC include chronic inflammation or irritation. It can have multiple locations such as the cheeks, nose, ears, hands, thighs etc. We present a patient with large, cauliflower-shaped mass of the fourth finger. A 60-year-old male presented with painful, cauliflower-shaped mass of 9cm*5cm of the fourth finger of the left hand. The tumor surface was exophytic, irregular, crossed by deep grooves. Disease history is 12 years, the mass was gradually growing. After the histopathological examination of skin biopsy, we have diagnosed pappilomatosis cutis carcinoides. There was no palpable lymphadenopathy. Routine blood investigations were with normal limits. Simple radiographs showed bony erosions. Hand magnetic resonance imaging was performed, an invasion into the bone and tendon was observed. Chest abdominal pelvic CT scan were normal. We performed a partial amputation of the fourth ray with safety margins (5mm) and a full-thickness skin graft. The histopathology of excisional mass border confirmed the tumor was removed entirely. He had no tumor recurrence or metastatic disease during follow-up for 4 years.

The present paper explores the various types of painters and artists mentioned by John Webster in The Duchess of Malfi. Much like the poisoned portrait in The White Devil, some of the painted and sculpted images that appear in The Duchess of Malfi seem endowed with equally terrifying power over whoever looks at them. Why do some pictures become perfidious in the tragedy? The play recurrently offers descriptions of how images are designed, focusing on the very material from which they are made and upon which they are impressed. Starting from an analysis of the material circumstances of picture-making as shown or described in the play, my contention is that Webster emphasizes the difference between metal crafts and ductile materials, which in turn opens onto a reflection upon time and sound in the creative process, thereby accounting for the pictures’ varying degrees of agency and toxicity.

Competing Interests: L'auteur déclare avoir des liens permanents avec l’entreprise Newclip Technics et avoir été pris en charge, à l’occasion de déplacements pour congrès, par ConMed.

Urology continues its development in minimally invasive surgery, and the year 2023 is marked by important innovations in the different approaches such as endoscopy, laparoscopy, and open surgery. The following innovations are instruments or medical devices which are still being evaluated. What they have in common is a questioning of our current practices, on the technical side but also for some of them on the ecological vision of our profession with the eternal debate of single use or reusable. Even if the evaluation of new devices is primarily medical and medico-economic, it is actually no longer possible to ignore the ecological aspect and the impact on the environment of the various new products. New technologies also make it possible to think about smart connected prostheses and precision intraoperative imaging that can ultimately guide the surgeon's hand., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Résumé Objectif Cette étude vise à déterminer la prévalence et les étiologies fongiques des onychomycoses des mains à Abidjan. Matériel et méthodes Des marchands de semoule de manioc au thon frit dénommée « garba » ont été inclus. De fines squames ont été examinées au microscope dans de la potasse à 30 %, tandis que les prélèvements séreux l’ont été dans du sérum physiologique. La culture sur milieux Sabouraud-chloramphénicol-actidione et Sabouraud-chloramphénicol des spécimens biologiques, a permis d’isoler et d’identifier les agents fongiques en cause. La sensibilité aux antifongiques a été réalisée par la technique sur gélose. Résultats Au total, 205 marchands de sexe masculin ont été inclus. La prévalence des onychomycoses était de 6,3 % ; (IC 95 % = 3,6–10,3). Cinq espèces de levures ont été identifiées. Celles du genre Candida étaient plus fréquentes (84,6 %). C. albicans représentait 30,8 % des levures du genre C andida . Trichosporon cutaneum a été isolé dans deux cas (15,4 %). L’amphotéricine B a présenté une meilleure activité antifongique (92,3 %), contrairement à la 5-fluorocytosine (30,8 %). Les sujets âgés de 15 à 24 ans (69,2 %), ayant une ancienneté dans le métier (84,6 %) et sans niveau d’instruction scolaire (69,2 %), étaient les plus atteints. La notion d’antécédent de mycoses unguéales ( p < 0,0001) et la coupure fréquente des ongles ( p = 0,0009) étaient significativement associées à l’onychomycose. Conclusion L’onychomycose à levures est peu fréquente. Le genre Candida était majoritairement impliqué. Il est néanmoins nécessaire de procéder à une sensibilisation sur les facteurs favorisant la mycose à l’endroit des sujets de l’étude. Summary Objective The aim of this study is to determine the prevalence and the fungi involved in onychomycosis located on fingers in Abidjan. Material and methods This study includes the sellers of cooked cassava semolina served with fried tuna fish called “garba”. Fines squames specimen was processed with 30% KOH for a direct microscope examination. Serous collection were done in physiological serum. Part of the original sample was cultured on Sabouraud medium with antibiotics (chloramphénicol, actidione). Species distribution and antifungal susceptibility by the technique on agar were noted. Results A total of 205 male sellers were involved. The Onychomycosis prevalence was 6.3%; (95% CI : 3.6–10.3). Five species of yeasts were identified. Candida spp were the most frequent (84.6%) and Candida albicans represented 30.8% of isolated yeasts. Trichosporon cutaneum were isolated in two case (15.4%). Susceptibility for amphotericin-B was 92.3% contrary to 5-fluorocytosine 30.8%. The subjects aged between 15 to 24 (69.2%), with a higher seniority (84.6%) and illiterate (69.2%) were the most affected. The main risk factors of fungal infections were the presence of previous fingernail onychomycosis ( P < 0.0001) and the frequent fingernail cutting ( P = 0.0009). Conclusion Onychomycosis caused by yeast is infrequent among “garba” sellers in Abidjan. The main fungi involved in fingernail onychomycosis were Candida species. It is nevertheless necessary to implement sensitization for them on contributing factors. [ABSTRACT FROM AUTHOR]

A 70 year-old man, farmer by profession consulted for a firm and painless nodule of the back of his right hand that was evolving since 09 years. The clinical examination revealed a subcutaneous nodular lesion; firm; immobile and painless. The diameter was about 0.8cm. The skin above was normal. Surgical excision was indicated. Intraoperatively the lesion was cystic and surrounded by a whitish membrane. Histological examination confirmed an epidermoid cyst who was abducted in totality. The occurrence of epidermoid cyst in hands can be explained by repeated trauma. It is seen most often in men "a manual worker." Clinically, it is about a firm nodule often sitting at the distal phalanx in size from 0.5 to 2cm. The Pulp location is the common location against in back of the hand which is possible but unusual, as in our patient. The overlying skin is normal or punctuated and the lesion is painless in half of the cases. Treatment is the complete surgical excision of the capsule and the overlying skin to avoid the risk of recurrence.

Résumé Les recommandations de bonnes pratiques pour la prise en charge de l’arthrose des membres mettent en avant la prise en charge non pharmacologique qui associe outre l’information et l’éducation, la pratique régulière d’un programme d’activité physique et la réduction pondérale. La prise en charge par l’activité physique concerne à la fois des exercices spécifiques et l’activité de type aérobie. Ces traitements physiques dont le niveau de preuve est élevé sont en 1 re intention prescrits et réalisés sous la supervision d’un professionnel de santé qualifié et doivent secondairement être intégrés au mode de vie pour être pratiqués régulièrement à moyen et long terme. Un travail complémentaire d’information voire d’éducation thérapeutique des patients est par conséquent indissociable de cette prise en charge. Le recours à l’appareillage est un traitement de seconde intention complémentaire des mesures citées précédemment. La prescription d’orthèses est très variable dans l’arthrose selon les praticiens (expérience, formation) mais mérite d’être considéré pour l’ensemble des patients en dépit d’un niveau de preuve intermédiaire. La formation spécifique des médecins et la mise à disposition d’outils d’aide à la prescription dans ce domaine semblent indispensables. Best practice guidelines for the management of limb osteoarthritis emphasize the non-pharmacological treatment that combines information and patients’ education, regular practice of a physical activity program and weight reduction. Physical activity programs involve both specific exercises and aerobic activity. These high evidence level treatments must be first prescribed and conducted under the supervision of a qualified health care professional. Secondarily, they should be integrated in lifestyle to be practiced regularly in the medium- and long-term. Further information or patients’ education are therefore inseparable. The use of orthosis is a complementary measure. Orthosis prescription varies in osteoarthritis according to physicians (professional experience, training) but deserves to be considered for all patients despite an intermediate level of evidence. The specific training of physicians and the provision of help decision tools seem therefore indispensable. [ABSTRACT FROM AUTHOR]

Giant cell tumors of the synovial tendon sheaths (GCTSTS) are a localized form of hemopigmented villonodular synovitis. They mainly affect the hands. This study aims to analyse the epidemiology, clinical and therapeutic characteristics of GCTSTS, to assess the results of surgical treatment and to identify risk factors for recurrences. We conducted a retrospective data collection from medical records of 50 patients with GCTSTS of the hand between 1992 and 2016 in the Department of Orthopaedics at the Hospital of Sahloul (Sousse-Tunisia). The clinical and epidemiological features of GCTSTS have been specified. The average age of patients was 33 years (9-69 years), the sex ratio was 0,6. Constant swelling (100%), joints inter-phalangeal mobilization trouble (6%) and digital pain (18%) were the most frequent reason for consultation. All tumors were located at the level of the digital region, especially at the level of the index (42%). It occurred on the palm of the hand in 66% of cases. All patients underwent surgery; macroscopically GCTTS appeared as an encapsulated polylobed and yellowish brown tumor, extending into the flexor tendons sheath(4 cases) and under the extensor tendon (2 cases). We noted a single case of recurrent cancer (2%) which was treated surgically. The functional results were good in all cases. The diagnosis of GCTTS should be evoked when there is evidence of digital swelling. Their management is based on surgery which is difficult and should be performed correctly to avoid recurrences. [ABSTRACT FROM AUTHOR]

Hand-foot-mouth disease (HFMD) is an acute viral infection that occurs usually among children in summer. This paper reports a high incidence of HFMD in children and adults, occurred in summer-autumn 2012 in the northeastern part of Romania. We present a few cases with some atypical clinical manifestations.

Musculoskeletal involvement is not uncommon in extra-pulmonary tuberculosis, but the localization in the soft tissue of the hand is a very rare. Diagnosis is much more difficult because of the atypical location and non-specific symptoms. We report 6 cases of pseudotumoral form of soft tissue tuberculosis of the hand treated in our department during the past 12 years. The mean age of the patients was 51 years with extremes of 44 and 63 years. A marked female predominance was observed (sex ratio = 0.2). All patients presented with swelling of the finger, two of which were painful swelling. All long fingers were involved; the thumb was involved in two cases. The histological study after excisional biopsy revealed caseating giant cell granulomas with epitheloid cells confirming the diagnosis. Antibacillary chemotherapy promoted healing and good outcome in our patients.

This review of the literature highlights the results of the recent randomized controlled trials about the management of systemic sclerosis (SSc) and its complications. The latest randomized studies have failed to demonstrate the utility against placebo of the injections of botulinum toxin A to achieve a better control of Raynaud's phenomenon and the efficacy of the adipose-derived cell transplantation for the treatment of hand dysfunction. Rituximab allows a significant improvement of cutaneous induration. The injections of mesenchymal stromal cells are well tolerated and should encourage future randomized trials to evaluate their efficacy. Finally, nintedanib and tocilizumab allow a reduction in the rate of decline of lung function, as well as a possible stabilization with tocilizumab., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Résumé Les malformations congénitales de la main regroupent un nombre important de situations cliniques. Leur expression est, comme dans toutes les pathologies congénitales, variable. De ce fait, on peut presque considérer que chaque situation clinique est un peu unique. La difficulté, comme toute la pathologie congénitale, réside dans le fait que les tableaux cliniques rencontrés sont extrêmement divers, difficilement classifiables. Aussi, la conduite à tenir et les décisions chirurgicales sont souvent affaire d’« École ». Ceci est d’autant plus vrai que l’évaluation des résultats est rendue difficile en raison des faibles séries (donc de leur valeur statistique) et de l’évaluation fonctionnelle qui sera due en partie à la croissance de l’enfant. Il est impossible en quelques pages de décrire la totalité des malformations du membre supérieur, de résumer leur prise en charge et d’évaluer les résultats obtenus. Aussi, ce chapitre ne sera pas exhaustif et nous nous attacherons essentiellement aux pathologies les plus fréquemment rencontrées. Summary Congenital deformities of the hand and upper limb include a significant number of clinical situations. Their expression is, as in all congenital diseases, variable. Therefore, we can almost consider that each clinical situation is a bit unique. The difficulty, as any congenital disease, is the fact that the clinical cases are extremely diverse and difficult to classify. So what to do and surgical strategies are often matter of “School”. This is even more true that the evaluation of results is very difficult due to low series (poor statistical value) and functional assessment to be partly due to the growth of the child. It is impossible in a few pages to describe all malformations of the hand and upper limb, summarize the indications and evaluate the results. Also, this chapter is not exhaustive and we will focus primarily on the most frequent pathologies. [ABSTRACT FROM AUTHOR]

Résumé Les traumatismes de la main chez l’enfant sont fréquents, représentant une part importante des motifs de consultation aux urgences pédiatriques. L’épidémiologie de ces lésions nombreuses varie selon l’âge et le contexte social de l’enfant. Leur prise en charge nécessite une bonne connaissance de l’environnement pédiatrique afin de reconstruire une main fonctionnelle tout en préservant le potentiel de croissance et en diminuant le risque de séquelles esthétiques. Nous décrirons les particularités de la traumatologie de la main chez l’enfant et leurs principes thérapeutiques. Summary Hand injuries in children are frequent in pediatric emergencies. Epidemiology of hand injuries in children depends on age and social context. The management of these injuries requires experienced pediatrics in order to obtain a functional hand to preserve the potential growth and to reduce the risk of cosmetic sequelae. We will describe the specificities of hand trauma in children and their therapeutic principles. [ABSTRACT FROM AUTHOR]

Treatment of unstable fractures of metacarpals and phalanges remains subject of controversy. Few series have been reported in the literature, making their analysis difficult. We provide a retrospective study involving 12 patients, operated on by this technique for displaced fractures of the metacarpals and phalanges, over a two year period. The final overall results were good in 75% of the cases, average in 16,5% of the cases and bad in 8,5% of the cases. Stability of mini plates in unstable fractures of the metacarpals and phalanges allowed early mobilization of hand joints, thus avoiding stiffness. [ABSTRACT FROM AUTHOR]

MASSON described glomus tumour as a benign neuromyoarterial proliferation. It represents approximately 1%-5% of all tumors of the hand. Pain is the main clinical sign. Definitive diagnosis is based on a body of evidence: clinical and radiological but only histology will allow confirmation. We conducted a retrospective study of 11 patient whose average age was of 36, 27 years (range 8-48 years), with a mean follow-up period of 34,40 months. All patients underwent surgical excision. This strategy allowed us to achieve satisfactory results. [ABSTRACT FROM AUTHOR]

The problem of present is analyzed as a reality given to man. First, the impersonal character of time is studied in its contradictory condition of opening place of giving: when present appears, there is not a giver, nor a receiver. In the second place, by considering the etymological sense of the French word "maintenant", it is showed that the "now" is a nullity between past and future, a dual interstice in which everything is reached or lost. Following the Kantian conception of time and the Derridian notion of "donation", the author highlights that the "now" is immediate receptivity, intuitive and not conceptual: in the present, man gives himself to himself and receives himself from himself. The present, at the same time that it constitutes the space of identity, it is also the vector of difference: when it becomes a sign to himself of himself, the present appears as his own alterity. The present duration, as it traduces the relation of man with himself, is a sign of alternation between coming and leaving; between dead and reparation. Finally, the mutations in the meaning of the notion of "promise" in Western history are investigated and understood as the experience of the now projected towards the future. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les brûlures électriques de la main chez l’enfant sont des accidents fréquents de la petite enfance. Matériels et méthodes On a réalisé une étude rétrospective intéressant 12 cas colligée dans le service de chirurgie plastique pédiatrique, hôpital d’enfants de Rabat entre janvier 2011 et février 2014. Résultat Il s’agit de douze enfants 6 garçons et 6 filles, deux entre eux ont été victimes d’une électrisation par un courant à haut voltage et 10 par un courant domestique. La prise en charge de nos patients a nécessité plusieurs techniques. Il n’existe pas de consensus thérapeutique, mais il faut tenir compte de plusieurs critères comme la profondeur de la brûlure, l’étiologie, la localisation et la croissance de la main. Summary Introduction Electric burns of the hand in children are common childhood accidents. Materials and methods We conducted a retrospective study of 12 interesting cases collated in the pediatric plastic surgery, Children's Hospital in Rabat between January 2011 and February 2014. Result It consists of twelve children 6 boys and 6 girls, two of them were victims of electrocution by high voltage current and 10 by household current. The care of our patients required several techniques. There is no therapeutic consensus, but several criteria such as, the depth of the burn, etiology, location and growth of the hand must be taken into account. [ABSTRACT FROM AUTHOR]

Résumé Introduction Le traitement chirurgical des syndactylies congénitales se base sur la création d’une néocommissure (reposant sur un lambeau commissural) et sur la gestion des faces latérales des doigts (s’appuyant sur des incisions en zigzag en miroir et sur une couverture des pertes de substance entraînées par la séparation des doigts par greffe de peau totale). Depuis leur apparition, il y a environ 30 ans, les substituts dermiques ont trouvé de plus en plus d’applications. Nous nous sommes donc interrogés sur l’apport de cette technologie dans la prise en charge de ces pertes de substance. Matériels et méthode Nous avons mené une étude monocentrique, rétrospective avec un seul opérateur. L’évaluateur était différent de l’opérateur. Les patients inclus étaient des enfants présentant une syndactylie congénitale simple ou complexe, complète ou non et associée ou non à une forme syndromique. Les enfants avec une syndactylie de première commissure étaient exclus. Le traitement chirurgical reposait sur la réalisation d’un lambeau commissural dorsal, d’incisions en miroir et sur une couverture des pertes de substance latérales par substitut dermique (Matriderm © ) avec la greffe de peau mince immédiate prélevée sur le cuir chevelu. Le critère principal d’évaluation était la qualité cicatricielle obtenue mesuré par le score OSAS. La rétraction commissurale (échelle de Whitney) et le temps opératoire représentaient deux des critères de jugement secondaires. Résultats Vingt commissures (11 enfants) ont été incluses entre 2008 et 2013. On retrouvait 14 syndactylies complexes. Le recul moyen était de 2,7 ans (0,5–5,5 ans). Les interventions ont eu lieu en moyenne à l’âge de 1,8 ans (0,5–4 ans). On retrouvait un temps opératoire moyen de 44,6 min (22–95 min). Les patients avaient un score OSAS moyen de 11,9 (6–18). Il était de 12,2 (60–20) dans les formes complexes et de 11,9 (10–16) dans les formes simples. Aucune pilosité n’a été retrouvée sur les greffes. Aucune complication sur le site donneur n’a été observée. Le score de Whitney était de 1,2 (0–3) et 3 commissures ont dû être réopérées. Conclusion L’utilisation d’un substitut dermique de type Matriderm © est une alternative novatrice et sérieuse dans le traitement des syndactylies congénitales. Ces résultats seraient donc à conforter par la réalisation d’une nouvelle étude comparant cette technique à la greffe de peau totale, méthode de choix pour les pertes de substance de la face latérale des doigts. Summary Introduction Surgical treatment of congenital syndactylies is based on the creation of a new commissure – with a commissural flap – and on the management of fingers lateral faces – with mirror zigzag incisions. Lateral skin defects are covered by full-thickness skin graft. Since their discover 30 years ago, dermal substitutes applications have been enlarged. We have wandered if these technique could be interesting for the treatment of these lateral skin defects. Materials and method We have launched a monocentric and retrospective study with only one surgeon. The assessor and the operator were different. Included patients have a simple or complex congenital syndactyly, complete or not, associated with a syndrome or not. Children with a first web space syndactyly were excluded. Surgical treatment was performed with a dorsal commissural flap, with mirror incisions and with a lateral skin defects coverage by dermal substitute (Matriderm © ) and split-thickness skin graft taken from the scalp. The initial assessment criterion was the quality of the scare measured by the OSAS score. Web creep (Whitney's scale) and time of surgery were two minor criteria. Results Twenty commissures (11 children) have been included between 2008 and 2013. Fourteen complex syndactylies were noted. The average aftercare was equal to 2.7 years (0.5–5.5 years). Interventions were performed at the age of 1.8 years (0.5–4 years). Surgical time was equal to 44.6 min (22–95 min). Patients OSAS score was 11.9 (6–18). It was 12.2 (60–20) for complex forms and 11.9 (10–16) for simple forms. Graft weren’t hairy. There was no complication on the donor site. Whitney's score was 1.2 (0–3) and three web spaces were reoperated. Conclusion We think that the use of dermal substitute Matriderm © is a new and serious alternative to treat congenital syndactylies. Results have to be confirmed by a new study which would compare this material to full-thickness skin graft, gold standard technique for these skin defects. [ABSTRACT FROM AUTHOR]

Résumé Les amputations bilatérales au niveau du membre supérieur sont des situations cliniques excessivement rares. Nous rapportons une situation clinique exceptionnelle d’amputation bilatérale au niveau des membres supérieurs à des niveaux différents : destruction de la main droite et amputation trans-humérale à gauche. Il s’agissait d’une tentative de suicide sous un train. Cette situation clinique nous a conduit à réaliser une réimplantation croisée de la main gauche au niveau de l’avant-bras droit. Seuls 4 autres cas ont déjà été publiés dans la littérature. Une fois l’indication chirurgicale posée de manière collégiale, avec toute la problématique éthique qui entoure cette décision, nous avons dû résoudre en urgence une problématique de concordance inversée des structures anatomiques : la technique opératoire est donc détaillée précisément. L’objectif de cette chirurgie est de sauver au moins un organe de préhension : la main. Le résultat fonctionnel obtenu est présenté et critiqué. Summary Bilateral amputations of upper limbs are excessively rare clinical situations. We report an exceptional clinical case of bilateral amputation of upper limbs at different levels: destruction of the right hand and left transhumeral amputation in a patient after an attempted suicide on train lines. This special situation led us to perform a cross-hand replantation of the left hand to the right forearm. Only 4 other similar cases have been published in the literature. Once the surgical indication had been formulated collectively, and taking into account all the ethical issues surrounding such a decision, we had to solve the issue of inverting anatomical structures in emergency. We have provided a detailed description of our surgical technique. The aim was to save at least one organ used for grasping. The result obtained is presented and reviewed. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Les pansements occlusifs des brûlures des mains de 2 e degré chez l’enfant doivent prévenir l’infection et favoriser les phénomènes de cicatrisation. Pour être réalisés correctement avec une bonne prise en charge de l’antalgie, ces soins nécessitent souvent que l’enfant soit hospitalisé. Notre objectif était de trouver une alternative au protocole de soin classique qui permettrait de diminuer le nombre de réfection de pansement et donc la durée d’hospitalisation. Nous rapportons notre expérience de l’utilisation des pansements Aquacel ® Burn à cette fin. Patients et méthode L’étude prospective monocentrique non randomisée a été menée de 2012 à 2014. Le gant était posé au bloc opératoire dans les 72 heures suivant l’accident chez des enfants âgés de moins de 15 ans présentant des brûlures isolées des mains de 2 e degré superficiel à profond. Une fois que le gant avait parfaitement adhéré à la brûlure, les enfants quittaient le service. Ils étaient revus 10 à 12 jours après l’accident pour s’assurer de l’absence d’indication de greffe de peau. Résultats Vingt gants ont été posés chez 16 enfants âgés de 16 mois à 13 ans. La durée moyenne de séjour (DMS) a été de 5 jours pour la pose du gant et 1 jour pour la dépose. 4 mains ont été greffées. Conclusion Après une période de familiarisation avec le produit, les gants Aquacel ® Burn ont permis de diminuer la DMS avant une éventuelle greffe de peau dans les cas des brûlures isolées des mains de l’enfant. Summary Aim of the study Occlusive dressings for second-degree hand burns in children must prevent infection and promote healing. For good management of analgesia, these treatments often require children to be hospitalized. Our goal was to find an alternative to conventional care protocol that would reduce the number of dressings and therefore the length of hospitalization. We report our experience with the use of Aquacel ® Burn. Patients and method Non-randomized monocentric prospective study was conducted from 2012 to 2014. The glove was used in the operating room within 72 hours after the burn in children younger than 15 years old with isolated superficial to deep 2nd degree hand burns. Once the glove was perfectly stuck to the burn, the children could go back home. We saw them 10 to 12 days after the accident to be sure there was no indication of skin graft. Results Twenty gloves were used in 16 children aged from 16 months to 13 years. The average length of stay (ALOS) was five days to put the glove on and one day to remove it. Four hands were grafted. Conclusion Once we get used to the product, Aquacel ® Burn gloves have reduced the ALOS before skin graft in cases of isolated hand burns in children. [ABSTRACT FROM AUTHOR]

Résumé La localisation digitale d’un fibrosarcome est une entité extrêmement rare. Nous rapportons l’observation d’un nouveau cas chez un homme de 25 ans qui présentait une volumineuse masse tumorale ulcéro-bourgeonnante de couleur rosâtre violacée, développée au niveau du médius gauche. Le diagnostic histologique était établi avant et après réalisation d’un traitement chirurgical à visée curative. Il s’agissait d’une amputation proximale du troisième rayon avec ostéotomie intracarpienne au niveau du capitatum selon la technique de Pezé et Iselin. Avec un recul de 2 ans, les résultats fonctionnels étaient satisfaisants et non émaillés de récidive locale ni de métastase à distance. Fibrosarcoma of finger is a very rare entity. We report a new case in a 25-year-old man admitted for an ulcerative and papillary large mass tumor, pinkish purplish color, developed in the left middle finger. Histological diagnosis was established before and after curative surgical treatment. Proximal amputation of the left third finger was performed with metacarpal extirpation and osteotomy in the capitatum according Peze and Iselin procedure. Two years later, functional results were satisfactory without local recurrence or metastasis. [ABSTRACT FROM AUTHOR]

Résumé: Les mains de blast résultent de la manipulation d’explosifs instables. Leur retentissement est fonctionnel et vital chez les polytraumatisés. Les auteurs rapportent leur expérience de la prise en charge des mains de blast en situation sanitaire précaire. Patients et méthodes: Entre 2001 et 2012, 33 mains de blast ont été prises en charge chez 30 blessés, civils et militaires, reçus en urgence, pendant et après un conflit armé. Résultats: Deux femmes (6,7 %) et 28 hommes (93,3 %) ont été reçus, dont quatre adolescents (13,3 %) et 26 adultes (86,7 %). Pendant la guerre, 15 agents en arme (50 %) et trois civils (10 %) ont été opérés, soit 60 % des blessés de la main. En temps de paix, les civils ont été majoritairement opérés dans 33,3 % des cas, contre 6,7 % des cas d’agents en arme. Dix-neuf mains de blast (57,6 %) ont été observées pendant la guerre et 14 en période de paix, soit 42,4 % des cas. L’âge moyen a été de 25,2ans, avec des extrêmes de 12ans et 50ans. Treize mains gauches (39,4 %) et 20 mains droites (60,6 %) ont été opérées. La lésion a intéressé toutes les structures anatomiques de la main. Elle a été unilatérale dans 27 cas (81,9 %) et bilatérale dans trois cas (9,1 %). Trois types de traumatismes de la main ont été observés. Les polytraumatisés avec traumatisme de la main (18,2 %), le traumatisme de la main grave et isolé avec des amputations proximales ou digitales (75,7 %), et le traumatisme de la main sans gravité apparente (6,1 %). La lésion associée a été oculaire (un cas), thoracique (un cas) et abdominale (cinq cas). Un parage a été réalisé en urgence immédiate (93,9 %) et différée (6,1 %). Le traitement a été une chirurgie d’hémostase, faite essentiellement d’amputations (69,7 %) et de régularisation de moignons digitaux (12,1 %). La réparation n’a été réalisée que dans 18,2 % des cas. Un décès a été observé chez un patient polytraumatisé avec des blast thoraciques. Conclusion: Les lésions par blast de la main sont fréquentes en temps de guerre chez les agents en armes. La population jeune, les travailleurs manuels et les enfants y paient un lourd tribut en temps de paix. Comme les pieds de mines, les mains sont exposées aux grenades instables laissées dans la nature. En situation sanitaire précaire, plutôt qu’une chirurgie de sauvetage fonctionnel de la main, c’est une chirurgie d’hémostase qui fait beaucoup de mutilés de la main. L’aspect psychosocial et la réinsertion professionnelle constituent des difficultés supplémentaires de la prise en charge. [Copyright &y& Elsevier]

Résumé: Au cours de la grossesse, la Haute Autorité de santé (HAS) recommande la réalisation de trois examens échographiques, notamment pour le dépistage de malformations congénitales. Or, dans notre expérience, le diagnostic échographique des malformations de la main est rarement établi en prénatal. Cette étude, rétrospective sur la période 2003–2008 et prospective sur la période 2009–2012, quantifie la sensibilité du diagnostic échographique des malformations de la main. Les questionnaires ont été envoyés à domicile ou soumis aux parents en consultation. L’acceptation du diagnostic par les parents et leur angoisse ont été évalués. Quatre-vingt huit malformations ont été recrutées dans notre étude. Seuls 11 diagnostics anténataux ont été posés. La sensibilité du diagnostic échographique est donc de 12,5 % dans notre série. Trente-neuf pour cent des parents ont été choqués à la naissance par l’absence de diagnostic. La sensibilité du diagnostic anténatal des malformations de la main est peu étudiée dans la littérature. Elle est généralement faible. On peut se poser la question de l’utilité de ce diagnostic pour des questions d’eugénisme et médicolégales. Les parents soulignent également qu’un diagnostic établi en prénatal aurait augmenté leur angoisse. Nos résultats soulignent les difficultés du diagnostic anténatal des malformations du membre supérieur et posent surtout plusieurs questions laissées en suspend : quelle information faut-il délivrer aux parents ? Faut-il légiférer les échographies anténatales ? Les malformations « mineures » sont souvent bien gérées par les parents mais les « majeures » ignorées posent souvent un problème médicolégal. [Copyright &y& Elsevier]

Résumé: L’arthroplastie avec une prothèse en pyrocarbone est une des options pour le traitement de l’arthrose de l’articulation interphalangienne proximale (IPP). La déficience de l’appareil extenseur, l’instabilité, la luxation et l’infection sont des causes plus fréquemment décrites pour les reprises. Nous rapportons le cas clinique d’une patiente opérée d’une arthroplastie avec une prothèse en pyrocarbone de l’articulation IPP du majeur droit, qui a présenté une fracture de l’implant 11 mois après la chirurgie, une complication rarement décrite dans la littérature pour ce type d’implant, mais qui nous fait évoquer la fragilité de ce type d’implant. [ABSTRACT FROM AUTHOR]