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Background Attention deficit hyperactivity disorder (ADHD) is a common co-morbidity that affects up to 44% of children with Down syndrome (DS). There is a need for reliable, good quality research on the use of methylphenidate within this population. The objective of this study is to report our experience regarding the management of ADHD in these children using methylphenidate. Methods This study is a retrospective observation of 21 children with DS, followed at Jerome Lejeune Institute between 2000 and 2018. The diagnosis of ADHD was made using the Diagnostic and Statistical Manual of Mental Disorders criteria. Efficacy was measured as response or non-response on two main symptoms: attention/concentration and hyperactivity/impulsivity. Safety was evaluated by the presence or absence of side effects. Results Sixteen out of the 21 children (76%) showed improvement with methylphenidate. The average age of treatment onset in responding children was 8 years and 10 months versus 6 years and 3 months in non-responders (P = 0.05). Average dose/weight was significantly different in responders and non-responders (0.82 vs. 0.54 mg/kg/day, respectively; P = 0.03). Twelve children out of 21 (57%) experienced side effects; only three experienced side effects severe enough to require treatment interruption. Most common side effects were loss of appetite and difficulties in falling asleep. Conclusion Methylphenidate was effective and safe in treating ADHD in 76% of cases in children with DS, with few serious side effects to report. Early diagnosis of ADHD is important to improve the quality of life, learning, inclusion and socialisation of children with DS.

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p

International audience; Background Diagnosis and treatment of colorectal peritoneal metastases at an early stage, before the onset of signs, could improve patient survival. We aimed to compare the survival benefit of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC), with surveillance, in patients at high risk of developing colorectal peritoneal metastases. Methods We did an open-label, randomised, phase 3 study in 23 hospitals in France. Eligible patients were aged 18-70 years and had a primary colorectal cancer with synchronous and localised colorectal peritoneal metastases removed during tumour resection, resected ovarian metastases, or a perforated tumour. Patients were randomly assigned (1:1) to surveillance or second-look surgery plus oxaliplatin-HIPEC (oxaliplatin 460 mg/m(2), or oxaliplatin 300 mg/m(2) plus irinotecan 200 mg/m(2), plus intravenous fluorouracil 400 mg/m(2)), or mitomycin-HIPEC (mitomycin 35 mg/m(2)) alone in case of neuropathy, after 6 months of adjuvant systemic chemotherapy with no signs of disease recurrence. Randomisation was done via a web-based system, with stratification by treatment centre, nodal status, and risk factors for colorectal peritoneal metastases. Second-look surgery consisted of a complete exploration of the abdominal cavity via xyphopubic incision, and resection of all peritoneal implants if resectable. Surveillance after resection of colorectal cancer was done according to the French Guidelines. The primary outcome was 3-year disease free survival, defined as the time from randomisation to peritoneal or distant disease recurrence, or death from any cause, whichever occurred first, analysed by intention to treat. Surgical complications were assessed in the second look surgery group only. This study was registered at ClinicalTrials.gov, NCT01226394. Findings Between June 11, 2010, and March 31, 2015, 150 patients were recruited and randomly assigned to a treatment group (75 per group). After a median follow-up of 50.8 months (IQR 47.0-54.8), 3-year disease-free survival was 53% (95% CI 41-64) in the surveillance group versus 44% (33-56) in the second-look surgery group (hazard ratio 0.97, 95% CI 0.61-1.56). No treatment-related deaths were reported. 29 (41%) of 71 patients in the second-look surgery group had grade 3-4 complications. The most common grade 3-4 complications were intra-abdominal adverse events (haemorrhage, digestive leakage) in 12 (23%) of 71 patients and haematological adverse events in 13 (18%) of 71 patients. Interpretation Systematic second-look surgery plus oxaliplatin-HIPEC did not improve disease-free survival compared with standard surveillance. Currently, essential surveillance of patients at high risk of developing colorectal peritoneal metastases appears to be adequate and effective in terms of survival outcomes. Copryright (C) 2020 Elsevier Ltd. All rights reserved.

Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. Patients and methods: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). Results: All groups (NA: n Z 42; ADJ: n Z 16; PO: n Z 16; NoC: n Z 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P Z 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P Z 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07e4.94; P Z 0.033). Conclusion: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.

Objectives The use of chest physiotherapy (CP) has not, to date, been shown to be effective in the care of infants hospitalized for bronchiolitis. However, it has not yet been studied in outpatient settings. The aim of our study was to examine the short-term benefit of CP with the increased exhalation technique (IET) on the respiratory conditions of nonhospitalized infants. Methods Our research consisted of a multicenter, randomized, controlled, single-blind study of infants under 1 year old. A decrease in the severity score of the infants' respiratory condition was compared between two groups: one receiving CP and one without CP. Eighty-two infants were randomized: 41 in the CP group and 41 in the control group. Blinded assessors determined the Wang Clinical Severity Score at inclusion (T0) and 30 minutes later (T1) for each group. Results Improvement in the severity score was observed for 29 infants (70.7%) in the group receiving CP, compared with 4 infants (9.76%) in the control group (p Conclusion For outpatient care of infants with bronchiolitis, the results of this study suggest that CP with IET leads to a short-term improvement of mucus airway obstruction parameters.

Background The peritoneal cancer index (PCI) is a comparative prognostic factor for colorectal peritoneal metastasis (CRPM). The ability of laparoscopy to determine the PCI in consideration of cytoreductive surgery remains undetermined, and this study was designed to compare it with laparotomy. Methods A prospective multicentre study was conducted for patients with no known CRPM, but at risk of peritoneal disease. Surgery began with laparoscopic exploration followed by open exploration to determine the PCI. Concordance between laparoscopic and open assessment was evaluated for the diagnosis of CRPM and for the PCI. Results Among 50 patients evaluated, CRPM recurrence was found in 29 (58 per cent) and 34 (68 per cent) at laparoscopic and open surgery respectively. Laparoscopy was feasible in 88 per cent (44 of 50) and deemed satisfactory by the surgeon in 52 per cent (26 of 50). Among the 25 evaluable patients with satisfactory laparoscopy, there was concordance of 96 per cent (24 of 25 patients) and 38 per cent (10 of 25) for laparoscopic and open assessment of CRPM and the PCI respectively. Where there were discrepancies, it was laparoscopy that underestimated the PCI. Conclusion Laparoscopy may underestimate the extent of CRPM.

International audience; Based on the importance of assessing the true extent of peritoneal disease, PeRitOneal MalIgnancy Stage Evaluation (PROMISE) internet application (www.e-promise.org) has been developed to facilitate tabulation and automatically calculate surgically validated peritoneal cancer index (PCI), and other surgically validated scores as Gilly score, simplified peritoneal cancer index (SPCI), Fagotti and Fagotti-modified scores. This application offers computer-assistance to produce simple, quick but precise and standardized pre, intra and postoperative reports of the extent of peritoneal metastases and may help specialized and non-specialized institutions in their current practice but also facilitate research and multicentre studies on peritoneal surface malignancies.

Resume Le doigt a ressort (ou a ressaut) est une pathologie frequemment rencontree par le chirurgien de la main, il est lie a une inadequation entre la taille des tendons flechisseurs et celle du canal digital, principalement au niveau de sa partie proximale, la poulie A1. Le doigt a ressort peut provoquer des douleurs, un ressaut, un blocage ou une diminution de la mobilite du doigt concerne. La grande majorite des doigts a ressort est d’origine primaire (idiopathique). Le diagnostic est aise dans un grand nombre de cas mais d’autres pathologies peuvent mimer un doigt a ressort (instabilite de l’appareil extenseur, blocage de l’articulation metacarpophalangienne [MP]) et doivent etre eliminees. Les principales methodes therapeutiques employees dans le doigt a ressort sont l’immobilisation, l’injection de corticoide et/ou la chirurgie. L’indication depend avant tout de la forme clinique du doigt a ressort.

Restoration of grip function was achieved through transfer of the recovered biceps tendon to the long digital flexors using a fascia lata graft in seven patients with complete brachial plexus palsy. Initial nerve repair was followed by biceps transfer with stabilising wrist and hand fusions. The biceps recovered to Medical Research Council (MRC) grade 4 in all cases. Patients were reviewed at a mean time of 26.7 (range 7–63) months after biceps transfer. After transfer, the total active movement of the digits averaged 55 (range 30–90)°. The strongest measurable grip strength was 6 kg. Patient satisfaction was high. The excellent excursion of the elbow provides a good basis for a transfer to power grip function, enabling a greater total active movement of the fingers to be achieved. We recommend this method as a useful adjunct to the treatment of the complete brachial plexus palsy.

Summary Background Progress in therapy and the ageing patients hospitalized with heart failure may have impacted the characteristics of this patients. Aims We compared epidemiological data of patients admitted with heart failure during two periods separated by a 10 year interval. Methods Characteristics of 353 heart failure patients recruited between 2002 and 2004 with those of 304 heart failure patients recruited between 1992 and 1994 were compared retrospectively. Results There is now a majority of male patients (56.4%) not found ten years ago. The average age is unchanged (75.1±11 then 76.4±11 years) even though the proportion of patients aged over 70 years has increased (75% versus 70%). Hospital length of stay has fallen from 14±9 to 10±7 days. Hospital mortality (8%) are identical. The two main etiologies remain coronary and hypertensive heart disease at 29 and 24% respectively but these proportions are lower than ten years ago (42 and 28% respectively). The ejection fraction is more often preserved (56%) than before (44%). Increased prescription of inhibitors of the renin-angiotensin system and beta-blockers is confirmed. Post-hospital and total mortality has fallen by 50 and 30% from 30 to 16% and 35 to 24% respectively at the expense of a 25% increase in the frequency of hospital readmissions from 29 to 38%. Conclusion Even if mortality has declined, heart failure remains a major public health burden with a significant number of hospital readmissions. Other approaches such as therapeutic education must therefore be developed.

International audience; Introduction Simulation as a method for practical teaching of surgical residents requires objective evaluation in order to measure the student's acquisition of knowledge and skills. The objectives of this article are to publish our evaluation and validation grids and also the measure of student satisfaction. Method A teaching platform based on practical exercises with a porcine model was created in 2009 at seven French University Hospitals. Three times a year, 31 Diplôme d’Études Spécialisées Complémentaires (DESC) surgical residents underwent timed assessment of the performance of five surgical tasks: trocar insertion (trocars) testing the convergence of instruments (convergence), intra-corporeal knot tying (knots), running of the small intestine to find a lesion (exploration), and performance of a running suture closure of the peritoneum (closure). Two experts evaluated performances prospectively on grid score sheets specifically designed and validated for these exercises. We measured time, scores on a rating scale, and the interest and satisfaction of the residents. Results Data for 31 residents between May 2011 and March 2012 were analyzed. Rating scales were statistically validated and correlated (Kappa correlation coefficient K > 0.69) for each task. The performance times of the most experienced residents decreased significantly for all tasks except for small bowel exploration (P = 0.2). After four sessions, times were significantly improved with better quality (fewer errors and higher average scores [> 88%]), regardless of the residents’ experience. Of the participants, 92% were satisfied, 86% thought that the sessions improved their technical skills and 74% thought it had a favorable impact on their clinical practice. Conclusion This study shows that the performance of surgical techniques can be improved through simulation, that HUFEG grids are valid, and that this teaching program is popular with surgical residents

Resume La dysplasie fibreuse, pathologie rare, a pour localisation elective l’extremite proximale du femur. Les fractures iteratives et la deformation en coxa vara sont les menaces evolutives les plus importantes chez l’enfant, principalement dans la forme polyostotique. Cette localisation represente le probleme orthopedique le plus frequent et la principale indication chirurgicale. Le but de cette etude etait d’analyser le resultat clinique et radiologique apres traitement chirurgical. Entre 1979 et 2001, 22 enfants ont ete operes pour dysplasie fibreuse de l’extremite proximale du femur. Huit patients etaient porteurs d’une forme monostotique et 14 d’une forme polyostotique. Dans la forme monostotique, le type de traitement chirurgical a ete fonction de la taille et de la localisation de la lesion et comportait systematiquement un curetage de la tumeur. Dans la forme polyostotique, le traitement chirurgical a comporte une osteotomie de valgisation avec « humeralisation » en cas de coxa vara associee a une osteosynthese interne, le plus souvent par enclouage centro-medullaire. Dans la forme monostotique, le resultat a ete juge cliniquement bon dans tous les cas avec disparition ou quasi-disparition de la lesion dans 75 % des cas. Dans la forme polyostotique, nous avons observe des corrections stables de la deformation par osteotomie de valgisation avec « humeralisation » montee par un clou. Les resultats ont ete moins bons en raison de fractures et de deformations. Au vu de la litterature et de nos resultats, le pronostic de la forme monostotique apres traitement chirurgical est globalement bon. Dans la forme polyostotique, une osteosynthese preventive est necessaire. L’osteotomie de valgisation avec « humeralisation » semble corriger et prevenir la deformation en coxa vara dans certains cas. Dans les formes les plus severes, un traitement par biphosphonates associe au traitement chirurgical offre de nouvelles perspectives.

Stiffness is a frequent condition in elbow pathologies, both traumatic and non-traumatic, and usually requires an operative treatment including an anterior capsulotomy. Elbow arthroscopy is certainly an alternative to surgery, but the technique of arthroscopic capsulotomy remains controversial. Our aim was to study the anterior elbow capsule anatomy to recommend an efficient and safe arthroscopic capsulotomy. We dissected ten cadaveric elbows and analyzed the insertions of the anterior capsule, their variations and the relationships with the surrounding neurovascular structures (radial and median nerve, brachial artery). The influence of elbow flexion was studied on fresh elbows with radioscopic evaluation. The distances between the anterior capsule and the neurovascular structures were measured at four reference levels. The insertions of the anterior capsule were also studied on the embalmed elbows. The radial nerve is always the closest structure to the capsule, but in this study it was always protected by the brachialis muscle. The distance between the anterior capsule and the neurovascular structures is consistently higher on the proximal side, regardless of which structure is considered. The 90 degrees flexion position allows the best capsular distension and offers optimal security with regard to neurovascular structures. All arthroscopic surgeons are concerned about potential neurovascular complications (varying from 0 to 14% in the literature). Previous anatomical studies examined the relationships between the arthroscopic portals and the neurovascular structures. This study developed a precise description of the relationship between the anterior capsule and the surrounding neurovascular structures, which let us recommend technical parameters to conduct a safe arthroscopic capsulotomy.

Biliary cysts are frequent hepatic manifestations. They are benign, single or multiple congenital lesions, with a female predominance. In more than half the cases, they remain asymptomatic; fortuitously detected during abdominal investigations, they are observable either by imaging (ultrasonography, CT scanning, MRI), either by surgery (laparoscopy or laparotomy). However, they may evolve and induce various complications: congestive attacks, intracystic hemorrhage, ruptures, infection, compression of the surrounding intra- or extrahepatic tissues. Treatment is indicated only in case of complication or pain. Although laparoscopic resection of the dome is the most frequently used treatment for about twelve years, the recurrence rate remains high. Besides, other therapeutic means exist, such as surgery (cystectomy, hepatic resection, hepatic transplantation) or non-surgical treatments (percutaneous radiological drainage, intracystic injection of sclerotic substances). All these methods have to be carefully discussed before selection, owing to various associated advantages, disadvantages and results.

Resume Le caecum est, en frequence, la deuxieme partie du colon concernee par le volvulus apres le sigmoide et avant l’angle gauche et le colon transverse. Cette affection survient sur des caecums anormalement mobiles. Le mecanisme du volvulus est la torsion ou la bascule. Le tableau clinique est celui d’une occlusion intestinale aigue par strangulation. La radiographie de l’abdomen sans preparation permet de poser le diagnostic dans plus de la moitie des cas. Elle montre le caecum distendu, donnant l’image en « grain de cafe » ou en « goutte de larme », associee a des niveaux hydro-aeriques de l’intestin grele, et a une absence d’air dans le colon. Le lavement aux produits hydrosolubles montre une opacification colique totale, et une absence d’opacification caecale, avec un arret du produit en « bec d’oiseau ». Le scanner montre une image pathognomonique que l’on nomme le « tourbillon » caecal. Le traitement vise a reduire le volvulus et a traiter les complications evolutives. La resection ileo-caeco-colique est la meilleure option therapeutique. Les caeco-colopexies peuvent dans de rares cas constituer une alternative therapeutique chez les sujets âges, ou sur terrain debilite et en l’absence de necrose.

Resume Cette etude porte sur 106 nourrissons et enfants atteints d'infections bacteriennes graves pris en charge du 1er janvier 1998 au 30 avril 2001 par les quatre SMUR pediatriques de l'AP-HP de l'Ile-de-France. 46,2 % sont des interventions primaires (domicile, cabinet medical, aeroport) et primo-secondaires (urgences hospitalieres) d'une part, 53,8 % sont des transports dits secondaires concernant des enfants hospitalises, victimes de complications bacteriennes graves du fait de leur maladie primitive d'autre part. Cinquante et un pour cent sont des meningites, a predominance pneumocoque et meningocoque, en incluant les purpuras fulminans. 20,75 % sont des chocs septiques chez des malades atteints d'affections chroniques (drepanocytose), de deficits immunitaires acquis ou congenitaux. 19,8 % sont des pneumopathies bacteriennes severes (staphylococcies pleuropulmonaires, coqueluches) ou virales surinfectees (bronchiolite a VRS, pneumopathies a mycoplasme pneumoniae et para influenzae III). Les auteurs etudient les differentes caracteristiques de ces deux groupes de malades, leur prise en charge immediate par l'equipe locale et le SMUR, enfin leur devenir a court terme. Soixante-cinq pour cent des enfants ont gueri apparemment sans sequelles, 19 % sont decedes et 16 % sont gueris mais au prix de sequelles importantes, surtout neurologiques. Les meningites a pneumocoque sont redoutables du fait de leur pronostic (dix deces, huit sequelles graves sur 26 cas), ce qui milite en faveur de la vaccination des nourrissons des l'âge de deux a trois mois par le nouveau vaccin conjugue a sept valences (Prevenar®). Ce vaccin, s'il avait ete fait dans cette serie de malades, aurait pu eviter huit deces et sept sequelles graves, si on y ajoute un choc septique a pneumocoque et une infection severe chez un drepanocytaire homozygote.

Fusarium moniliforme culture material toxicity containing fumonisin B1 (FB1) was investigated into four groups of five growing ducks, each receiving 0, 5, 15 or 45 mg/kg FB1 by daily oral administration over 12 days. Treatments did not lead to lethality, but the average body weight gain was slightly retarded in treated versus control animals, without apparent dose relation. A dose-dependant increase of the liver weight with a disorganization of the span and implementation of a microglandular structure in both periportal and centrolobular areas was obtained. In the plasma, together protein, cholesterol, alanine aminotransferase, lactate dehydrogenase, gammaglutamyl tranferase and sphinganine to sphingosine ratio (SA/SO) were increased. No sign of apoptosis was present neither in the liver nor in peripheral blood lymphocytes and only moderate oxidative damages were obtained. These results are of interest, because although FB1 increases SA/SO and is hepatotoxic in all investigated species, liver hyperplasia with increased liver weight were obtained in ducks, whereas decreased liver weight and apoptosis are observed in rats. Finally, although ducks appeared resistant to FB1 toxicity in terms of mortality, liver alterations were obtained with only 5 mg/kg per day of FB1 for 12 days. Considering the fact that high levels of FB1 may occur in corn (100–300 mg/kg), liver pathology could have an impact in farming conditions.

Resume But de l’etude : La chirurgie laparoscopique du foie en est encore a ses debuts. Le but de cette etude etait de rapporter une serie de tumeurs solides et kystiques du foie traitees par voie laparoscopique. Patients et methodes : Entre avril 1991 et decembre 1999, 32 patients porteurs de lesions hepatiques ont ete operes par voie cœlioscopique. Il s’agissait de 15 patients ayant des lesions kystiques non parasitaires (kystes biliaires volumineux [ n = 11], polykystoses [ n = 4]), et de 17 patients ayant 18 tumeurs solides : hyperplasie nodulaire focale ( n = 8), angiome ( n = 6), adenome ( n = 2), metastase d’un cancer colique gauche ( n = 1) et carcinome hepatocellulaire ( n = 1). Quinze fenestrations simples ou multiples et 18 exereses hepatiques ont ete realisees par laparoscopie : une hepatectomie droite, cinq lobectomies gauches, deux sous-segmentectomies IVb, une segmentectomie III et neuf tumorectomies. Resultats : Une conversion a ete necessaire (3 %) en fin d’intervention (lobectomie gauche pour carcinome hepatocellulaire) pour confirmer la marge de securite au niveau de la tranche de section. Le diametre moyen des tumeurs solides etait de 6,5 cm et celui des lesions kystiques solitaires de 15,7 cm. La duree operatoire moyenne des exereses hepatiques a ete de 232 minutes. La mortalite postoperatoire a ete nulle. La morbidite a comporte dans chaque groupe un cas d’occlusion de l’intestin grele par hernie interne au niveau d’un orifice de trocart survenue a j5 et a j7, ayant necessite dans les deux cas une resection intestinale segmentaire. La duree moyenne de sejour postoperatoire a ete de 5,6 jours dans les tumeurs solides et de 7,5 jours dans les lesions kystiques. Dans le groupe des lesions kystiques, le taux de recidive etait de 50 % apres un suivi moyen de 5,5 mois. Conclusion : La chirurgie laparoscopique du foie semble realisable en toute securite mais necessite au prealable une experience de la chirurgie hepatique classique et une parfaite maitrise de la chirurgie cœlioscopique. Seules les lesions de siege anterieur, qu’il s’agisse de tumeurs benignes symptomatiques ou atypiques, de kystes, ou de polykystoses de type I, peuvent etre traitees par l’abord laparoscopique. Pour les lesions malignes, les indications restent a preciser.

Resume But de l'etude : La rupture spontanee d'un carcinome hepatocellulaire (CHC) est un accident grave entrainant un hemoperitoine abondant mettant en jeu le pronostic vital. Le but de ce travail etait de rapporter une serie retrospective de 22 cas observes dans le meme centre. Patients et methodes : De 1978 a 1998, 22 patients (18 hommes et quatre femmes, âge moyen : 63 ans, extremes : 18–83 ans) ont ete traites pour un CHC rompu sur foie cirrhotique dans 17 cas, et sur foie sain dans cinq cas. Dans 14 cas, le diagnostic d'hemoperitoine aigu a conduit a une laparotomie en urgence. Le siege de la rupture predominait au niveau du lobe gauche (huit cas). L'operation realisee a consiste en une lobectomie gauche ( n = 7), une hepatectomie droite ( n = 2), une exerese tumorale ( n = 4), une ligature de l'artere hepatique ( n = 5), et une hemostase directe ( n = 4). Resultats : La mortalite postoperatoire globale a ete de 45,4 % ( n = 10). Sur les 12 survivants, neuf sont decedes dans un delai de 6 a 29 mois. Trois patients etaient vivants au moment de la realisation de ce travail avec un recul de 32, 40 et 66 mois. Conclusion : La rupture aigue d'un CHC impose le plus souvent une intervention en urgence avec une mortalite elevee. La resection tumorale est le procede le plus efficace mais n'est pas toujours realisable en urgence. La fissuration permet de realiser des examens complementaires et une eventuelle embolisation arterielle preoperatoire avec des resultats immediats meilleurs.

A patient underwent at his birth, an ureterosigmoidostomy for exstrophic bladder. Fifty-six years later, she presented a carcinoma on the right ureterosigmoidostomy associated with chronic urinary infection. She underwent a right ureteronephrectomy and sigmoidectomy. Chronic alterations of the colic mucin by urines lead to carcinoma.

Purpose The aim of this study is to analyse the results of a series of pedicled latissimus dorsi transfers to restore elbow flexion. Moreover, we describe a new technique of distal fixation of the muscle to the proximal third of the ulnar diaphysis to increase the lever arm and improve strength. Methods We retrospectively reviewed seven patients aged from 18 to 49 years. Elbow flexion paralysis was secondary to destruction of the anterior arm compartment in four cases and to brachial plexus palsy in three cases. The humeral insertion of the latissimus dorsi was relocated on the coracoid process in five cases and not relocated in two cases. The patients were assessed using the Medical Research Council grading system, the maximum weight lifted by the wrist and the active elbow range of motion. Results At the last follow-up (mean 26.6 months), five patients recovered M4 elbow flexion strength (0.5 to 8 kg), one patient recovered M3 strength and the last transfer failed because of triceps brachii co-contractions. The mean active elbow flexion was 91° (range, 45 to 130°). Patients with destruction of the anterior arm compartment and particularly whose forearm was not paralyzed had better strength than patients with a brachial plexus palsy (3.25 versus 1 kg). A skin island with the latissimus dorsi muscle flap was particularly useful in case of arm soft tissue defect. Discussion A destroyed anterior compartment of the arm is a good indication for latissimus dorsi transfer to restore elbow flexion. The muscle is usually too weak in high brachial plexus palsy. Finally, the latissimus dorsi needs an objective, reproducible and reliable preoperative evaluation. Level of evidence Level IV.

We describe a case of ruptured mesenteric artery branch aneurysm. Since it is characterized by nonspecific clinical manifestations, aneurysm in this uncommon location is usually diagnosed following complications. Definitive diagnosis requires Doppler ultrasound followed by arteriography. The purpose of this report is to describe the pitfalls of diagnosis and define an appropriate management strategy. Unlike abdominal aortic aneurysm, isolated aneurysms of the superior mesenteric artery (SMA) branches are rare. Most cases are diagnosed after the occurrence of complications. Early diagnosis would be useful, since the natural course can be tragic without timely treatment. In this report, we describe one case of ruptured mesenteric artery branch aneurysm and review the literature for relevant data on the circumstances of discovery, methods of investigation, and appropriate management of these lesions.

Isolated fracture of the scaphoid with an associated anterosuperior dislocation of the proximal fragment is an extremely rare injury. We present two cases where open reduction and internal fixation through a palmar and dorsal approach was performed. No instances of non-union, necrosis of the proximal fragment of the scaphoid or scapholunate dissociation were noted during a mean follow-up period of 18 months. Clinical results (active motion, power grip, DASH) following such injury and intervention are presented. The aetiology of this rare injury is discussed.

It has been many years now since the introduction of nerve transfers for repair of traumatic brachial plexus lesions and more recently, we have seen its application in the field of obstetric brachial plexus palsy. These nerve transfers do not represent an alternative to anatomical repair by means of nerve grafting, but represent an additional possibility to increase the reconstructive options and improve the final results. This pushes the surgeon to decide: which function is to be restored by nerve grafting, which one by nerve transfer? What is the more reliable procedure? Does the age of the patient, the delay after the accident, or the type of accident influence this choice? If we add in the possibilities of palliative treatment, one can state that many therapeutic options are available today for brachial plexus reconstruction, and that no real consensus does exist. But some tendencies, some trends are apparent.

Section I: Brachial Plexus Injury and Entrapments Section II: Upper Extremity Peripheral Nerve Injuries and Entrapments Section III: Lower Extermity Peripheral Nerve Injuries and Entrapments Section IV: Nerve Tumors, Painful Nerve Conditions, and Miscellaneous Injuries.

Introduction Sleep-disordered breathing (SDB) is commonly in chronic heart failure (CHF) patients. Exercise training (ET) improves exercise tolerance and reduces cardiac decompensations in CHF population. Otherwise, ventilation therapy (VT) improves prognosis and exercise capacity in CHF patients with SDB. However, the effect of the combination therapy: ET and VT is still unexplored. The aim of our study is to evaluate the effects on hemodynamic status (cardiac decompensations) of ET and VT in stable CHF patients referred to cardiac rehabilitation (CR). Methods We included 118 stable CHF patients with an apnea-hypopnea index (AHI) > 15/h diagnosed by polygraphy. They were randomized into exercise training (ET group n = 58) or combined exercise and ventilation (ET + VT group n = 60). The follow up period was the 8 weeks during which 20 exercise training sessions were scheduled. Severe episodes of cardiac decompensations were recorded. Results The mean age was 62.6 ± 10.3 years, 89% were males, 50% NYHA class II and 50% in class III, mean LVEF was 30%. 40% and 60% of patients had respectively obstructive and central and/or mixed apneas, with a mean AHI 34.4 ± 14.3/h. Patients of ET + VT group had significantly fewer acute cardiovascular events than those of ET group (2/60 vs. 9/58; 3.3% vs. 15.5%, P Conclusion Ventilation therapy combined with ET in severe CHF patients seems to reinforce benefits of ET alone. Screening of SDB in CR could be proposed in order to optimize the global management of the heart disease.

International audience; Sphinganine concentration (Sa) and sphinganine to sphingosine ratio (Sa/So) are sensitive biomarkers of fumonisin B1 (FB1) exposure in animals and have been proposed to reveal FB1 exposure in humans. They correlate with liver and kidney toxicity and often precede signs of toxicity. However, the use of Sa and Sa/So is confusing during chronic exposure. Indeed, some authors report altered sphingolipids metabolism, whereas others fail to demonstrate significant effect. The aim of this study was to investigate the kinetics of Sa and Sa/So in the serum of ducks over a 77-day exposure to 0, 2, 8, 32 and 128 mg FB1/kg feeds. Serum biochemistry was also investigated to reveal hepatotoxicity. The results obtained indicate that the kinetics of sphingolipids and serum biochemistry are closely linked with the duration of the exposure. After a strong and rapid increase Sa and Sa/So decrease then stabilize. The lowest investigated dose able to determine a detectable effect is 2 mg/kg feeds, the Sa/So ratio being the most sensitive biomarker of FB1 exposure.

The kinetics of free sphinganine (Sa), sphinganine to sphingosine ratio (Sa/So), proteins, cholesterol, alanine aminotransferase (ALAT) and lactate dehydrogenase (LDH) were investigated in the course of fumonisin B1 (FB1) exposure in ducks (20 growing males divided into four groups of 5 receiving, respectively, a daily dose of 0, 5, 15 or 45 mg/kg FB1 via oral administration over 12 days). Descriptive statistics of these parameters were also studied in a large number of ducks not exposed to mycotoxins and free of known pathology. Although the toxin at the end of the treatment affected all the parameters investigated, only 2 days of treatment appeared necessary to increase free Sa concentrations in serum, whereas 6 days were necessary to detect a significant effect on Sa/So ratio. Significant differences between control and treated ducks were observed after 4 days of treatment for ALAT and LDH and after 6 and 8 days for cholesterol and proteins concentrations. The minimum doses of FB1 required to determine an effect were assessed using three different methods. This approach reveals that FB1 has greater effects when it is ingested at a low dose for a long time than when ingested at a high dose for a short time. Although the minimum toxic dose of FB1 in ducks remains to be determined, this result must be considered in the context of chronic exposure to the toxin, not only in avian populations.

Background/Purpose. Portal triad clamping and total or intermittent hepatic vascular exclusion are usually used to reduce blood loss during major liver resections. We report, in this retrospective study, the results of right hepatectomy without vascular clamping. Methods. From January 1986 to July 2001, 87 right hepatectomies, including 14 extended right hepatectomies, were performed without vascular clamping. There was 53 men and 34 women, with a mean age of 60.2 ± 12.5 years. Indications were 58 metastases, 16 hepatocellular carcinomas, 5 cholangiocarcinomas, 4 adenomas, 3 angiomas, and 1 carcinoid tumor. All the procedures were carried out using an ultrasonic dissector and intraoperative ultrasonography with only vascular control (looping of the hepatic pedicle and supra; and infrahepatic vena cava). Results. There were four postoperative deaths and 23 complications (26%), including hepatocellular failure (6), pulmonary complications (6), transient bile leakage (5), digestive bleeding (2), subphrenic abscess (1), inferior vena cava (IVC) thrombosis (1), disseminated intravascular coagulation (DIC; 1), and evisceration (1). Forty-two patients (48%) had no blood transfusion. The mean blood transfusion requirement was 1.5 ± 2.7 units. The mean operative length was 280 ± 60 min and the mean hospital stay was 12.8 ± 8.1 days. Liver function test results were similar to those in other studies on days 1, 4, and 7 postoperatively, with a return to normal values after 1 week. Conclusions. In our experience with major liver resections, vascular clamping is not necessary.

We report the case of a patient who underwent splenectomy for spontaneous rupture of the spleen due to splenic metastasis. Pathologic examination revealed diffuse infiltration by carcinoma. Chest X-ray revealed a right lung superior lobe tumor, related to poorly differentiated carcinoma. Total splenectomy is a good option for diagnosis and treatment of splenic metastases.

In this study, the authors described a new videoscopically guided approach for tunneling in esophagoplasty and insertion of an esophageal prosthesis.

Specially designed automatic disposable staplers are proving to have an important role in wound closure. Staple closure is accomplished with significantly less damage to the wound defenses than with the least reactive suture. A comprehensive evaluation of the mechanical performance of the commercially available staplers demonstrates that the Premium™ stapler is superior to the other staplers.

Introduction It is essential to provide complete information to patients using non-steroidal anti-inflammatory drugs (NSAIDs) because of the risk of side effects. Today, most healthcare professionals recommend and privilege oral information regarding NSAIDs. Objective Evaluate the impact of three standardized NSAIDs information-delivery modalities on knowledge, anxiety and satisfaction of patients hospitalized in a Physical Medicine and Rehabilitation unit for debilitating and degenerative locomotor diseases. Method Randomized prospective study with an alternate month design. Two control groups were provided with only one type of information modality: written (information sheet) or oral (presentation). The intervention group received both modalities of information. The information included: the definition of NSAIDs, advantages and side effects, and practical advice regarding proper use. The main evaluation criterion was knowledge progression assessed by a specific questionnaire. Secondary criteria were anxiety evolution (STAI-Y questionnaire) and satisfaction related to the information delivered. Results One hundred and forty patients were included. Knowledge was improved in the three groups, with a greater score improvement in the group that received both modalities (P = 0.05). No intergroup difference was noted on anxiety or satisfaction. Discussion and conclusion Associating both information-delivery modalities (written + oral) contributes to improving knowledge but does not seem to have an impact on the anxiety of patients treated with NSAIDs for their degenerative locomotor disease. Using standardized information sheets with a validated content could help pharmacists in their role as healthcare education provider and effectively complement the information delivered orally.

l -[1,2- ethyl - 14 C]Ethionine was given ip and iv to rats. The dose was 0.8 mg/kg and the injected activity was 100 μCi/kg. Whole-body autoradiography was performed on all rats. We noted the highest uptake of radioactivity in the pancreas; both exocrine and endocrine portions were labeled. In the liver, there was an accumulation of radioactivity from the first to the sixth hour after treatment followed by a decrease. Ethyl ethionine was also concentrated in the renal medullae (30 min after the injections) and in other organs: eyes (lens and uvea), cartilage, and several glands.

Autoradiographic studies demonstrated that in the rat kidney radioactivity was localized mainly in the medulla in animals injected with [14C]ethionine, whereas it was distributed homogeneously throughout the whole parenchyma in rats given [14C]methionine. This difference of distribution was consistent with a difference in renal toxicity: a single i.p. dose (1 g/kg) of ethionine induced a slight but persistent (6 days) damage to kidney tubule cells evidenced by an increase of urinary GGT and slight disturbance of renal function, such damage was not observed with methionine.