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Resume Introduction L’instabilite anterieure du genou entraine la survenue de lesions meniscales et femorotibiales, mais peut egalement entrainer des lesions osteochondrales patellaires dont le demembrement reste au second plan. Hypothese Le but de ce travail etait d’evaluer la survenue de lesions de chondropathies patellaires chez les patients presentant une rupture du LCA et d’en etudier les caracteristiques en fonction du delai de laxite. Materiel et methode Dans une etude retrospective, nous avons revu 250 dossiers de patients âges en moyenne de 32 ans, operes entre janvier 1995 et janvier 2005 d’une laxite anterieure du genou sous arthroscopie (photographies arthroscopiques, comptes-rendus operatoires et fiches de renseignement arthroscopiques). Les lesions chondrales ont ete etudiees a l’intervention selon les classifications de Bauer et Jackson et de l’International Cartilage Repair Society (ICRS). Les analyses statistiques ont ete realisees au moyen du test de Kruskal-Wallis et du test exact de Fischer. Resultats Soixante-douze patients (28,8 %) presentaient une atteinte chondrale patellaire. Le versant lateral etait touche dans 41 cas (56,9 %). Les lesions se situaient majoritairement au tiers moyen de la patella. Il s’agissait de lesions superficielles (stade 1 et 5 de Bauer et Jackson ; grade 1 de l’ICRS) dans deux tiers des cas. Nous avons pu mettre en evidence une aggravation statistiquement significative du grade ICRS en fonction de la duree de laxite preoperatoire. Discussion Peu de publications dans la litterature concernent l’atteinte patellaire lors de laxite anterieure du genou ; cependant, nos resultats sont comparables a ceux des rares series retrouvees. Les mecanismes lesionnels ne sont pas encore precisement identifies et necessiteraient des etudes biomecaniques. Conclusion La presence de lesions patellaires est frequente en cas de laxite anterieure (28,8 % dans notre serie) et le delai est correle a une aggravation statistiquement significative de ces lesions. A l’heure actuelle, l’evaluation de ces lesions patellaires reste au second plan par rapport aux lesions meniscales et femorotibiales, cependant, l’histoire naturelle de la rupture du LCA semble evoluer vers une atteinte degenerative de tous les compartiments du genou, y compris du compartiment femoropatellaire.

Resume L’immobilisation en rotation externe (RE) des luxations anterieures d’epaule semble diminuer leur taux eleve de recidives. Notre etude IRM evalue l’incidence de la RE sur les lesions labrales et capsuloligamentaires postprimoluxation. Tout premier episode de luxation antero-interne sans antecedent traumatique beneficiait d’une IRM en rotation interne (RI), puis en RE pour etudier l’hemarthrose, le degre de RE, la coiffe des rotateurs, les lesions osseuses, le labrum. On denombrait 24 patients d’âge moyen, 37 ans. Le delai moyen d’obtention de l’IRM etait de 3,7 jours. La RE moyenne de 37°, modifiait l’hemarthrose dans 75 %, reduisait les labrums separes et la poche capsulaire anterieure. Nous retrouvons comme dans la litterature, une reductibilite constante mais incomplete du labrum en RE ainsi qu’une diminution du volume capsulaire anterieur. Des etudes cliniques a long terme confirmeront l’interet de cette immobilisation dans la prevention de l’instabilite scapulohumerale.

Treatment of comminuted intra-articular fractures of the distal humerus in elderly patients remains a challenge in trauma surgery. These fractures are rare, but their frequency increases. Our multicenter studies collected 238 cases of comminuted intra-articular fractures of the distal humerus in patients older than 65: two hundred and five cases for the retrospective study, 33 for the prospective study with a minimum follow-up of six months. The following criterias were studied: age, sex, state of health (with ASA score), functional scores (with Katz score), osteoporosis by the OST score and dual X-ray absorptiometry. The results were evaluated according to the Mayo Elbow Performance Score (Morrey) and the Quick DASH. X-ray studies were performed in order to assess both results for prosthesis and osteosynthesis. The following criteria were studied: bone healing, quality of reduction, signs of arthritis (Broberg-Morrey), prosthetic position, mechanical complications, prosthesis fixation. There were 80% of women in good health according to the ASA score (more than 70% of ASA 1 or 2). Most of them (80%) were self-governing and living at home. Hundred and seventy-two patients had an osteosynthesis and 44 had a prosthetic reconstruction (like Coonrad-Morrey prosthesis). Patients treated with osteosynthesis were younger (mean age was 77) than those treated with prosthetic reconstruction (mean age 81). Mean follow-up was 32 months. Results of osteosynthesis were good and excellent for 77% of the patients. Complications occurred for 20% of patients with a reoperation rate of 13%. Results of prosthetic reconstruction were good and excellent for 83% of the patients with 14% of complications and 6% of reoperation. Prosthetic reconstruction seemed to be better than osteosynthesis according to the Mayo Clinic score (84 points versus 77 points for the retrospective study and 95 points versus 75 points for the prospective study). However, the statistical analysis was not significant. Treatment of these fractures must be discussed according to the physiological status of the patient and the fracture patterns (scan evaluation). In conclusion, osteosynthesis remains the standard treatment when stable fixation is feasible. However, prosthetic reconstruction should be discussed for dependant patients or with comorbidity factors, bad bone quality leading to poor osteosynthesis or complex fracture.

This is a retrospective analysis of patients aged over 60 years treated in a single center for intra-articular fractures of the distal humerus. Outcomes were compared with published results for osteosynthesis and arthroplasty.The cohort included 34 patients (36 fractures) reviewed at mean 35 months. Mean age was 77.6 years. Fracture types were: C1: 8, C2: 10, C3: 18. The transtricipital posteromedial approach was used in the majority of patients. Fixation was achieved with a prebent lateral plate (n=11 fractures), a Y-plate (n=9), two plates (n=4), pins or screws (n=9) and an external fixator (n=3). Outcome was assessed with the Mayo elbow score, the Bröberg radiographic score and patient satisfaction. The social impact was also noted.The mean Mayo elbow score was 73.3; outcome was excellent (n=13), good (n=8), fair (n=5) and poor (n=10). Pain persisted in 23 patients. The mean range of movement was 80 degrees . Patient satisfaction remained good. Ten patients did not recover their preoperative level of autonomy. Radiological signs of osteoarthritis were noted for 75% of patients and nonunion of the humeral fracture in 32%. There were three superficial infections and four neurological lesions.Good and very good outcome was noted for 59% of the osteosyntheses in this series, compared with 71% in the literature. The rate for arthroplasty is 95%. The mean range of motion is 101 degrees , 17% of patients with a prosthesis complain of pain, 5% develop a superficial infection and 6.5% suffer neurological injury. The estimated rate of revision for arthroplasty is 11% at 7 years.Beyond the age of 65 years and based on evidence reported in the literature, it would be advisable to prefer another mode of treatment for these intra-articular fractures, for example elbow arthroplasty, particularly for comminutive fractures on osteoporotic bone.

Traumatic lesions of the colon associated with fracture of the acetabulum occurs in less than 2% of the cases. Direct perforation of the colon by a bony spike, which occurred in our patient, is even more exceptional. We were unable to find any other case reported in the literature. This case illustrates the importance of looking for intestinal lesions in all patients with pelvic injury presenting an unexplained infectious syndrome. Imaging provides clear evidence for avoiding late diagnosis and life-threatening situations.

There is a general consensus concerning the clinical and radiological approach to diagnosis and proper management strategy in patients with sciatalgia subsequent to disk herniation. Recurrent herniation is the most probable diagnosis when pain recurs the same territory long after surgery. Despite advances in computed tomographic and magnetic resonance imaging, it may be difficult to identify the real source of the pain in some patients. We report a patient with renal cell cancer who developed recurrent sciatic pain which did not respond to disk surgery. This case illustrates the need for an extensive work-up before implicating the spine as the cause of recurrent sciatalgia.

Proust's first formulation of the law of definite proportions was published in a paper on iron oxides (1794). He spent the major part of his professional life in Spain, where he contracted to take a teaching and searching position. He was apprenticed to his father to study pharmacy, and he studied chemistry with Hilaire-Marin Rouelle. His early interrupted education is shown through his abilities as an analyst, the persons with whom he was in communication, his share in manufacturers' assays and his researches towards health and food chemistry. More fundamental was his belief in natural principles of order as representative of the thought of the ideologues.

Aging is classically accompanied by a dysregulation of the immunologic machinery. As a consequence, the immune response developed in senescent organisms is usually inappropriate, often inefficient, sometimes aberrant, and potentially detrimental. The age-associated immune dysfunction may be implicated to some degree in the extreme susceptibility of the elderly to infection and neoplasia and may even participate in various aspects of senescence. The current understanding of the molecular mechanisms underlying immunosenescence is still fragmentary. The most extensively studied phenomenon is the progressive decline in the proliferative capacities of T lymphocytes with aging. The loss of proliferative potential in response to antigenic challenge is a characteristic feature of immune senescence. It is directly implicated in the emergence of the age-related immune deficiency. The purpose of this review is to show how the accumulation of various biochemical lesions with advancing age leads to the failure of a critical cell function, namely the activation-induced lymphocyte proliferation. The biochemical modifications responsible for the defect in transduction and execution of the proliferative signal are analyzed as a function of age. The multiple alterations observed on the various biochemical pathways may appear as a consequence of a unique deleterious mechanism more fundamentally related to the process of senescence such as the inability to cope with oxidative stress.

Immune senescence is usually understood as a progressive and unavoidable decline of the immune function with increasing age. In the light of recent observations, this classical concept needs to be revised. More than just a simple waning of activity, immune senescence appears as a true dysfunction in the immune system. On the biological level, the age-related changes of the complex network of interactions between the various participants of the immune system result in the loss of some activities and in increase of other activities. On the clinical level, the disturbances of this interactive network lead to an inefficient and sometimes inappropriate or aberrant immune response. A better understanding of the molecular basis of immune senescence will hopefully allow the identification and characterization of the underlying mechanisms. Prevention and treatment of some aspects of age-associated immune dysfunction are already possible by hormone replacement therapy.

The aim of this study was to evaluate the biocompatibility of radicular sealing cements with agarose cell culture. The two cements studied were Sealite and Pulp Canal Sealer with different mixing times. In the experimental conditions used the cytocompatibility of Sealite was better than that of Pulp Canal Sealer. The cytotoxicity of both products was not negligible and corresponded to those of other studies with Pulp Canal Sealer and a cement with amount similar composition to Sealite. Because theses cements are currently used with success in humans, the results of this test raise the question of extrapolation to man.

The prospective study of evaluation temporomandibular dysfunction by air computerized tomography of the joint are reported. The authors propose a new injection technique of both articular compartments by CT Scan location. With thin sagittal computed tomography sections, closed mouth and open mouth position, this study is made. Preliminary data from air computerized tomography of the joint imaging show directly the disk with anterior and posterior attachments. The authors present the normal results and major pathology found in the evaluationof temporomandibular dysfunction. CT Scan puncture is more precise. The air computerized tomography imaging of the joint was undoubtedly superior to that of conventional opaque joint tomography, but dynamic notion is much less than in the absence of videoscopy.