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To date, indications for distal femoral varus osteotomy (FVO) in cases of associated patellofemoral osteoarthritis (PFO) have yet to be clarified. The purpose of this prospective study is to assess the short-term symptoms, functional and radiological impact of a medial closing-wedge femoral varus osteotomy on the patellofemoral joint in patients with valgus deformities who are afflicted with lateral tibiofemoral osteoarthritis (LTFO) associated with PFO.Fourteen patients (15 knees) received a medial closing-wedge femoral varus osteotomy. The functional impact of an FVO on the patellofemoral joint was assessed based on the KOOS-PF (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral Subscale), the Kujala score and the patellofemoral symptoms. Realignment of the patella was measured by the Merchant's patellofemoral congruence angle. The pre- and post-operative symptoms and functional scores were compiled prospectively and compared two years after the surgery.The Kujala patellofemoral functional scores and the KOOS-PF showed considerable improvement with a differential of +37.5 points ± 20.4 and +42.7 points ± 19.3 (p .01) respectively. The average Merchant's congruence angle went from 8.8° laterally to 3.6° medially, resulting in medialization of the patella, with a significant difference (p .01). Based on the specific clinical analysis of the patellar joint, preoperative J-sign was identified in 26.7% of patients (n = 4) and was not found during postoperative examination (p = .1). Preoperative apprehension test was identified in 33.3% of patients (n = 5) against 13.3% (n = 2) after surgery (p = .39). Preoperative pain extension test was identified in 40% of patients (n = 6) against 20% during postoperative clinical analysis (p = .43).Although the threshold of significance for patellofemoral symptoms was not reached, the medial closing-wedge femoral varus osteotomy induces a significant medialization of the patella (Merchant's congruence angle) and improves short-term functional results even with co-existing patellofemoral osteoarthritis. Due to the lack of specificity of the patellofemoral scores, patellofemoral osteoarthritis improvement is difficult to determine on its own, but does not represent a contraindication to FVO.III. Prospective clinical study.

Lactic acid and base deficit (BD) values are frequently monitored in the intensive care unit and operating room setting to evaluate oxygenation, ventilation, cardiac output, and peripheral perfusion. Although generally obtained from an arterial cannula, such access may not always be available. The current study prospectively investigates the correlation of arterial and peripheral venous values of BD and lactic acid. The study cohort included 48 patients. Arterial BD values ranged from −8 to 4 mEq/L and peripheral venous BD values ranged from −8 to 4 mEq/L. Arterial lactic acid values ranged from 0.36 to 2.45 μmol/L and peripheral venous lactic acid values ranged from 0.38 to 4 μmol/L. The arterial BD (−0.4 ± 2.2 mEq/L) was not significantly different from the peripheral venous BD (−0.6 ± 2.2 mEq/L). The arterial lactic acid (1.0 ± 0.5 μmol/L) was not significantly different from the peripheral venous lactic acid (1.1 ± 0.6 μmol/L). Pearson correlation coefficients demonstrated a very high correlation between arterial and peripheral venous BD ( r = .88, P < .001) and between arterial and peripheral venous lactic acid ( r = .67, P < .001). Bland-Altman plots of both pairs of measures showed that the majority of observations fell within the 95% limits of agreement. Least-squares regression indicated that a 1-unit increase in arterial BD corresponded to a 0.9-unit increase in peripheral venous BD (95% confidence interval [CI]: 0.7-1.0; P < .001) and a 1-unit increase in arterial lactic acid corresponded to a 0.9-unit increase in peripheral venous lactic acid (95% CI: 0.6-1.2; P < .001). These data demonstrate that there is a clinically useful correlation between arterial and peripheral venous lactic acid and BD values.

We assessed the incidence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) on admission, the rate of acquisition during the hospital stay and the relationship with subsequent infection in a digestive disease unit. The efficacy of a program of nasal carriage eradication with mupirocin was evaluated simultaneously. Over one year 484 patients were studied prospectively on admission for nasal and stool carriage of MRSA, then every week for nasal carriage. Nearly 70% (68.8%) of patients had chronic liver diseases. Nasal carriers were assigned to a five-day course of intranasal mupirocin ointment. One hundred and seventeen (24.2%) patients were MRSA positive, 57 (11.8%) of which were carriers on admission and 60 (12.4%) acquired carriage. Of these, 86 were treated with mupirocin with a success rate of 98.8% and 25.9% of them recolonized. Fourteen patients were retreated, to allow eradication in 71.4% of cases. Seventy percent of these became carriers again. One high-level mupirocin-resistant strain was isolated before treatment and seven during or after treatment. Hospital stay and stool carriage were independently associated with reacquisition (P = 0.0105 and P = 0.0462, respectively). Molecular analysis showed identity between the strains isolated from infection samples and from nasal swabs during the same week. For every patient who became recolonized, nasal strains isolated before and after eradication were the same in 70% of cases. Mortality during hospital stay was independently associated with age (P = 0.0081), MRSA nasal carriage (P = 0.02631), MRSA infection (P0.0001) and liver disease (P = 0.0017). This study did not show a change in the prevalence rate of infection in the unit during treatment with mupirocin. This treatment should only be attempted once due to the risk of emergence of high-level resistant strains.

We report the case of an unexpected respiratory complication after a surgical treatment of scoliosis during postoperative period in an adolescent patient. This complication results of a vascular compression of the left main bronchus between the aorta and the pulmonary artery, which induces severe atelectasis of left lower lobe. Prolonged non-invasive ventilation with high level of positive end-expiratory pressure prevents aorto-pulmonary compression, allows a pulmonary recruitment associated with a favorable prognostic for the adolescent.

We used successfully Airtraq-combined to a gum-elastic boogie to intubate twice a dysmorphic infant with mucolipidosis, in whom direct laryngoscopy failed. If this result is confirmed by prospective studies, Airtraq could be a first-line device to intubate infants with difficult intubation.

Background We studied 63 ASA I children (age 2–8 yr) to determine the sufentanil dose needed to facilitate intubation under excellent conditions after inhalation induction with various end-tidal concentrations of sevoflurane without neuromuscular block. Methods Subjects were allocated randomly to receive sevoflurane end-tidal concentrations (e′ sevo ) of 2.5%, 3%, or 3.5%. Anaesthesia was induced with sevoflurane 6% without nitrous oxide for 2 min, and then inspired sevoflurane concentration was adjusted to keep e′ sevo at 2.5%, 3%, or 3.5% according to the group. Subjects received i.v. sufentanil according to an ‘up and down' design. Tracheal intubation by direct laryngoscopy was performed 6 min after sufentanil injection. Intubation was considered successful, if intubation conditions were excellent as determined by the laryngoscopist. Results The ED 50 [effective dose for 50% of subjects; mean (sd)] of sufentanil required for excellent intubation conditions was 0.6 (0.12), 0.32 (0.10), or 0.11 (0.07) μg kg −1 for e′ sevo of 2.5%, 3%, or 3.5%, respectively. Using logistic analysis, the 95% effective dose (ED 95 ) of sufentanil was 1.02 [95% confidence intervals (CI) 0.31–1.74] μg kg −1 , 0.58 (95% CI 0.17–0.99) μg kg −1 , or 0.28 (95% CI 0.04–0.52) μg kg −1 for e′ sevo of 2.5%, 3%, or 3.5%, respectively. Conclusions Excellent intubation conditions could be obtained in children after inhalation induction with low sevoflurane concentrations and adjuvant sufentanil.

Background: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Like the LMA-ProSeal, it has an airway tube and a gastric drain tube. Little is known about its efficiency in pediatric anesthesia. Methods: Fifty children above 30 kg, ASA I–II, undergoing a short-duration surgery were included in this prospective, observational study. We evaluated ease in inserting the I-gel®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: All devices were inserted at the first attempt. The mean seal pressure was 25 cmH2O. There was no gastric inflation and gastric tube insertion was achieved in all cases. The results appear similar to those in a previous study concerning laryngeal mask airway in terms of leak pressure and complication rates. Conclusion: Because the I-gel® has a very good insertion success rate and very few complications, it seems to be an efficient and safe device for pediatric airway management.

Infants with Pierre Robin syndrome are known to be difficult to intubate. We evaluated the paraglossal approach combined with a gum elastic bougie for intubation of these infants. Whilst under general anaesthesia, a conventional laryngoscopy was performed; if it failed to obtain a laryngoscopic grade I or II view, intubation was attempted using a paraglossal approach and a gum elastic bougie. Six consecutive infants were studied. Conventional laryngoscopy failed in all infants whilst the paraglossal approach combined with a gum elastic bougie was successful in five of the cases. The paraglossal approach combined with a gum elastic bougie made intubation easy in most children with severe Pierre Robin syndrome and difficult laryngoscopy. Therefore we recommend this as the first line for airway management in such children. However, a fibreoptic bronchoscope and an anaesthetist trained in fibreoptic intubation must still be present when dealing with severe Pierre Robin syndrome infants.

To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients. This new system for treating lumbar degenerative pathologies is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions.We analyze series of 94 patients in whom this system was used. 62 were males and 32 females with an average age of 46.4 years. The pathologies treated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and 24 months, assessing the clinical picture according to the Oswestry scale and the return to work.The final results on the Oswestry scale were 21.4% with respect to 56.8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections.The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe that the follow-up should be increased.

Per- and postoperative analgesia of patients with chronic pain is a challenging issue for anaesthetists and can be achieved with locoregional anaesthesia, unless it is contraindicated. We report the case of a thrombocytopenic child presenting for thoracotomy and in whom intravenous analgesia failed after previous surgeries. Due to the central origin of the thrombocytopenia, thoracic epidural analgesia could be achieved, after platelet transfusions. When clinical advantage of thoracic epidural is unquestionable, central thrombocytopenia is a relative contraindication.

To compare the Classic laryngeal mask airway (MLC) and the ProSeal LMA (MLP), size 2 and 2.5 in terms of ease of insertion, leak pressure and side effects during insertion and extraction in the recovery room.Randomised prospective.All children between 10 and 30 kg scheduled for general anaesthesia with laryngeal mask (ML) were included. There was no imposed protocol for the anaesthesia. The ML size was determined according to the child's weight. The MLC was inserted using the standard technique. The MLP was inserted following the recommendations, with or without the handle according to the operator's choice. The data analysed were: insertion type, ease of insertion of the mask, of the nasogastric tube (SG), number of attempts of mask insertion, complications, gastric leaks.One hundred (and) twenty children were included. There was no statistical difference in terms of difficulty of insertion, number of failed attempts, leak pressure or side effects. The use of the handle did not make insertion easier. Insertion of a nasogastric tube was possible in 92% cases.MLP is as easy to use in children as the MLC. MLP has the advantage of allowing rapid access to the stomach. It seems that the MLP is safer since its correct position is confirmed by easy gastric tube insertion.

Thirty cases of pituitary tumour have been operated on in the last five years by a transfrontal approach, using microsurgical technique. Three cases of postoperative blindness are described, with an analysis of possible contributory factors and causative mechanisms, prognosis, and measures to lessen the risk of this complication. The possibility of an impairment in the chiasma blood supply is discussed. Although the use of the microscope makes the removal of the so-called capsule an easier surgical task, it is recommended that this structure should be left undisturbed.

Prostate specific antigen (PSA) is a prostate tissue marker detected by immunostaining in 97% of specimens examined. Tissue staining is variable and cancers are more heterogeneous than normal or hyperplastic prostate. Serum PSA levels in patients with normal or hyperplastic lesions are 12 ng/ml + 19 and are positively correlated with the weight of the gland. In patients with carcinoma serum PSA levels are 216 ng/ml + 782 and are positively correlated with tumor spread. PSA assay is of little value for screening for prostatic carcinoma. However, carcinoma of prostate is more frequent when PSA levels are above 10 ng/ml and the level of 50 ng/ml indicates capsular penetration, seminal vesicle or lymph node involvement or metastatic spread.

The incidence of chronic lymphocytic leukaemia has been studied over 4 years (1980-1983) in the region of Côte-d'Or (population 478,008). The crude annual incidence rate was 7.0/100,000 for males and 3.5/100,000 for females. The corresponding age standardized rates were 5.6 and 1.8. The sex ratio was 3.1. Compared to other population based registries, the incidence is higher in Côte-d'Or and the rates are among the highest reported in the world for males and females. Age and sex specific incidence rates were low before 50 years of age and increased in older age with a male predominance. The risk of chronic lymphocytic leukaemia was slightly higher in urban than in rural areas. All cases were classified according to Binet's classification: 74% were staged O or I. The ABC classification was applied to cases diagnosed in 1982-1983: 83% were staged A. These results suggest that cases diagnosed in a well-defined population are less severe than those reported in hospital statistics.

About two fibroid inflammatory polyps of the stomach and 84 similar cases previously reported in the world literature the authors describe the anatomo-clinical features of this entity. The two sexes are equally affected by such a lesion which occurs with a maximum of frequency during the 6th and the 7th decades. More often an epigastralgia with or without anemia is the main symptom of this polyp which is located in the antral submucosa (95% of the cases). A sessile or pedunculated mass is discovered by gastric endoscopy and may be resected during this investigation. Histologic examination shows a well limited fibroblastic proliferation around vessels and an inflammatory infiltration with a variable density of eosinophilic polynuclear cells. The presence of these elements is not a proof for the allergic nature of the polyp: blood eosinophilia is absent or rare and the serum IgE level is not changed.

The authors report a case of neonatal hepatitis with alpha-1-antitrypsin occuring in a child of ZZ phenotype. The anatomopathological study carried out on two liver biopsies showed changes of common cholestatic hepatitis developing into cirrhosis, as well as intrahepatocytary globulins. Moreover, these globulins, P.A.S. positive after treatment by alphaamylase, fix an antialpha-1-antitrypsine antiserum. Ultrastructural analysis shows them to be masses of amorphous material, feebly osmiophilic, outlined by a unitary membrane the moniliform aspect of which recalls the ergastoplasmic membrane. These findings are identical to those already made in cases of cirrhogenous neonatal hepatitis by alpha-1-antitrypsine deficit reported in the literature. They point out the irreversibility of the affection which, after a stage of cholestatic hepatitis with or without inflammatory portal fibrosis, develops into cirrhosis. At this stage cholestasis has regressed or disappeared whereas portal sclerosis, often infiltrated with free elements, surrounds hepatic lobules and biliary neocanaliculi. But the globulins are still present and appear to be the specific feature of this deficit. By their ultrastructural and immuno-histochemical features, these globulins would represent a form of accumulation of alpha-1-antitrypsin in the hepatocytes which normally carry out the synthesis of this antienzyme. Accumulation in the hepatocytes proves excretory disturbance of hypothetical mechanism: structural anomaly, changes in the permeability of the membrane. Its role in the occurrence of hepatitis or cirrhosis lesions is still to be demonstrated but one may think that it consists in absence of inhibition of the enzymatic factors discharged during agressions.