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Resume Introduction Le conflit postero-superieur est la premiere cause de douleurs chroniques d’epaule chez le sportif avec arme ou lancer. Lorsque le traitement chirurgical est preconise, il n’y a pas de consensus sur les techniques utilisees et les series publiees ont peu de patients et de recul. L’hypothese principale de l’etude etait que le traitement chirurgical permettait la reprise du sport au meme niveau ou superieur. L’hypothese secondaire etait que certains facteurs epidemiologiques, anatomiques pre- et peroperatoires et certains gestes chirurgicaux permettaient un meilleur resultat sur la reprise du sport au meme niveau ou superieur. Methodologie Cent trente-cinq patients operes de l’epaule pour conflit postero-superieur sous arthroscopie avec l’un des gestes suivants : capsuloraphie anterieure, capsulotomie/ectomie posterieure, debridement du bourrelet postero-superieur, glenoidoplastie posterieure, debridement ou reparation d’une lesion des tendons de la coiffe des rotateurs, ont ete inclus de maniere retrospective dans l’etude avec un minimum de un an de recul. Ils ont ete separes en deux groupes : groupe A : reprise du meme sport au meme niveau ou superieur ; groupe B : reprise du meme sport a un niveau inferieur, changement de sport, arret du sport. Deux scores (KJOC et Constant) ont ete utilises pour l’analyse subjective et objective de la fonction de l’epaule. Resultats Le recul moyen etait de 7,9 ans. Quatre-vingt-dix pour cent des patients ont repris le sport dont 52 % a un niveau identique ou superieur. Les facteurs favorisant la reprise du sport au meme niveau etaient en analyse univariee et multivariee : le sexe masculin, l’existence d’une lesion de coiffe en peroperatoire et’l'absence de geode trochiterienne a l’imagerie preoperatore. Lee debridement de la lesion de coiffe etait un facteur favorisant uniquement en analyse univariee. La capsuloraphie anterieure etait associee a plus de douleurs postoperatoires. Discussion Le taux de retour au sport au niveau anterieur est peu comparable a celui des series de la litterature du fait de sports pratiques differents et de techniques chirurgicales tres variables. Le caractere favorisant de la presence d’une lesion de la coiffe des rotateurs est une notion qui va a l’encontre de la plupart des series publiees. Les differences entre les sports pratiques en Europe continentale et dans les pays de culture anglo-saxons pourraient expliquer certaines des differences retrouvees. Niveau de preuve IV.

Internal impingement of the shoulder (IIS) is a specific disorder of young overhead-throwing athletes that was first described in 1991. The many non-operative and surgical treatments suggested to date have produced mixed outcomes. The objective of this study was to compare the practices of surgeons in France versus other countries regarding the diagnosis and treatment of IIS.Diagnostic and therapeutic practices regarding IIS differ between surgeons in France and in other countries.A 21-item questionnaire in French and English was emailed to the 1300 members of the French Arthroscopy Society and to surgeons from countries other than France. The questionnaire collected information on knowledge about IIS (2 items), the frequency of IIS in clinical practice (2 items), the diagnosis of IIS (6 items), the non-operative and surgical treatment of IIS (3 and 5 items, respectively), and return-to-sports rates after treatment for IIS (3 items).The completed questionnaire was sent back by 261 surgeons, 206 in France and 55 in other countries, including 42 in Japan. Among the respondents, 90% knew about IIS. Experience with IIS in terms of number of patients seen or surgical treatments performed was greater in the international group (45% vs. 19% in France, p0.001). Posterior shoulder pain in the arm cocking position was the most widely recognised symptom (99% in France, 74% internationally, p0.001), followed by excessive external rotation during arm abduction (55% vs. 65%, p=0.23). The most commonly sought lesions were those of the postero-superior labrum and articular surface of the rotator cuff. Rotator cuff debridement was among the surgical options according to most respondents (74% vs. 70%). In contrast, postero-superior glenoidplasty was cited almost only by surgeons in France (67% vs. 4%, p0.001). The proportion of patients who are able to return to sports was estimated at 50% to 75% by most respondents.Most respondents had theoretical knowledge about IIS, but surgery was rarely performed in France. Only very few athletes in France play baseball, which is responsible for most sports injuries of the shoulder seen in Japan. This fact, combined with differences in the lesions or even the diagnoses, may have contributed to the differences in the responses to the survey items between the French and international groups.

Resume Introduction La prise en charge des ruptures massives de la coiffe des rotateurs symptomatiques ne fait pas l’objet de consensus. L’objectif de cette etude etait de comparer le resultat clinique de differentes options therapeutiques d’une rupture massive de la coiffe des rotateurs. Hypothese Il existe une place pour la chirurgie arthroscopique dans le traitement des ruptures massives des tendons de la coiffe des rotateurs. Materiel et methode Il s’agit d’une etude prospective multicentrique non randomisee incluant les patients presentant une rupture massive de la coiffe des rotateurs, pris en charge par traitement medical (MED), tenotomie/tenodese arthroscopique isolee du long biceps (TLB), reparation tendineuse partielle arthroscopique (RPC), lambeau de grand dorsal (GD) ou prothese totale d’epaule inversee (PTEI). L’evaluation clinique etait basee sur le score de Constant, SSV et ASES a 3, 6 et 12 mois. Resultats Deux cent dix-huit patients (âge moyen 69 ans) ont ete analyses : 71 MED, 26 TLB, 61 RPC, 25 GD, 35 PTEI. Au recul de 12 mois, les scores moyens de constant, SSV et ASES etaient respectivement de 70 points, 68 %, et 73 points, avec un gain significatif quel que soit le traitement par rapport a l’etat preoperatoire. Seul le groupe PTEI presentait une amelioration sur l’ensemble des parametres du score de constant. L’elevation anterieure active progressait significativement pour le groupe MED (+25°), RPC (+26°), ainsi que PTEI (+66°). Seule la PTEI a permis une discrete amelioration de la rotation externe active (+10°, p = 0,046). Le gain en rotation interne etait significatif pour le groupe MED (+1,6 points) et RPC (+1,7 points). Conclusion Les techniques arthroscopiques (TLB, GD, RPC) de prise en charge des ruptures massive et irreparables des tendons de la coiffe des rotateurs permettent une amelioration fonctionnelle significative. Une reparation tendineuse partielle et une PTEI semblent apporter de meilleurs resultats qu’une la TLB isolee ou un lambeau de GD. Niveau de preuve III Etude prospective non randomisee.

Resume Introduction Le conflit postero-superieur de l’epaule correspond par definition a un contact de la face profonde de la jonction des tendons des muscles supra-epineux et infra-epineux avec le labrum postero-superieur, en position d’abduction et de rotation laterale maximales. Il en resulte le plus souvent une lesion significative ou non de ce tendon et un delabrement labral postero-superieur en miroir. Hypothese L’objectif primaire etait de definir si ce contact etait observe de facon systematique chez les patients ne presentant pas de lesion de la coiffe des rotateurs. Methodologie Cent epaules chez 100 patients ont ete inclues dans cette etude. Tous les patients ont ete operes en position semi-assise. Apres introduction de l’arthroscope par voie posterieure, la presence ou non d’un contact entre la face articulaire de la coiffe et le labrum postero-superieur etait notee lors de la realisation d’un mouvement d’arme du bras a 90° d’abduction et 90° de rotation laterale (arme 90/90) puis d’un mouvement d’arme du bras a 140° d’abduction et une rotation laterale maximale (arme 140/Max). Resultats Un contact a ete observe dans 69 % des cas pour l’arme 90/90, et dans 94 % des cas en position d’arme 140/Max. Nous avons retrouve une correlation entre l’existence de lesions de la coiffe et/ou du labrum et la realisation d’un mouvement d’arme du bras regulier chez le patient concerne (p = 0,035). Discussion Le contact entre la face profonde du tendon du muscle supra-epineux et le labrum postero-superieur est physiologique. Le fait de repeter un mouvement d’arme du bras peut etre responsable de lesions macroscopiques de la face profonde de la coiffe et du labrum postero-superieur. Niveau de preuve IV, etude fondamentale.

Resume Contexte Le conflit postero-superieur (CPS) est une pathologie specifique des jeunes sportifs avec lancer en arme, decrite en 1991. De nombreux traitements medicaux et chirurgicaux ont ete proposes avec des resultats mitiges. Objectif Comparer les pratiques diagnostiques et therapeutiques d’un groupe de chirurgiens francais avec un groupe de chirurgiens etrangers concernant le CPS. Methodes Un questionnaire comprenant 21 questions a ete produit en francais et en anglais et envoye par courrier electronique aux 1300 membres de la SFA (groupe France) et a des chirurgiens non francais (groupe Monde). Le sondage interrogeait sur la connaissance de la pathologie (2 questions), sa frequence en pratique clinique (2), son diagnostic (6), son traitement medical (3) et chirurgical (5), et les resultats du traitement sur la reprise du sport (3). Resultats Deux cent soixante et un chirurgiens (206 France, 55 Monde dont 42 du Japon) ont repondu au questionnaire. Quatre-vingt-dix pour cent d’entre eux avaient connaissance de la pathologie. Les chirurgiens nonfrancais sondes avaient une experience plus importante de la pathologie par le nombre de cas vus en consultation ou pour la pratique chirurgicale (19 % vs 45 %, p Discussion Le CPS est une pathologie connue sur le plan theorique par la majorite des interroges mais la chirurgie reste rare en France. La pratique du base-ball, tres rare en France mais responsable de la majorite de la pathologie sportive de l’epaule au Japon, ainsi que la presence de lesions voire de diagnostics differents pourraient expliquer certaines differences mises en evidence par ce sondage.

Background To date, medical history and dedicated questionnaires are the fastest and easiest way to assess risks of joint metal hypersensitivity. No published studies determined the overall prevalence of hypersensitivity to metals in patients with shoulder pathologies. The purpose of this study was therefore to estimate the prevalence of metal hypersensitivity reported by patients with shoulder pathologies, and to identify patients at risk of joint metal hypersensitivity based on a dedicated questionnaire. Methods The authors prospectively asked all adult patients consulting for shoulder pathologies between September 2018 and February 2019 at 10 centers to fill in a form. The main outcome was “reported hypersensitivity to metals,” comprising belt buckles, coins, earrings, fancy jewelry, keys, leather, metallic buttons, piercings, spectacles, watch bracelets, or zips. Results A total of 3217 patients agreed to fill in the survey, aged 55 ± 16 (range, 18-101) with equal proportions of men (51%) and women (49%), and a majority of patients consulting for cuff pathology (55%). A total of 891 (28%) patients had professions considered at risk for metal hypersensitivity. The most frequently reported metal hypersensitivities were fancy jewelry (15%), earrings (13%), and watch bracelets (9%). A total of 629 (20%) patients, of which the vast majority were women, reported hypersensitivity to 1 or more metals. Conclusions This survey of 3217 patients identified 20% who reported metal hypersensitivities, though only 2.2% had done patch tests. Matching profiles of those with positive patch tests to those with no patch tests revealed that 9.4% of the total cohort had similar sex and self-reported metal hypersensitivities. Factors associated with a positive patch test were female sex, self-reported cutaneous allergy, and self-reported metal hypersensitivity. The clinical applicability of these estimates remains uncertain as there is insufficient evidence that allergy to metal implants can be predicted by questionnaires or patch tests.

Background Internal impingement of the shoulder (IIS) is the leading cause of chronic shoulder pain in overhead throwing athletes. No consensus exists about which techniques are optimal when surgery is in order. The available studies are limited by small sample sizes and short follow-ups. The primary objective of this study was to assess return-to-sports (RtS) outcomes after surgical treatment for IIS. A favourable RtS outcome (RtS +) was defined as returning to the previous sport at the same or a higher level. Hypothesis The main hypothesis was that surgical treatment resulted in an RtS + outcome. The secondary hypothesis was that epidemiological factors, pre- and intra-operative anatomical factors, and specific surgical procedures were associated with higher RtS + rates. Material and methods A retrospective multicentre design was used. We included 135 patients with IIS managed arthroscopically using any of the following procedures: anterior capsulorrhaphy, posterior capsulotomy/capsulectomy, postero-superior labral debridement, posterior glenoidplasty, and rotator cuff tear debridement or repair. Follow-up was at least 1 year. The patients were divided into two groups based on whether they had an RtS + outcome as defined above or an RtS − outcome defined as a return to the previous sport at a lower level, a switch to another sport, or an inability to engage in any sport. The Kerlan-Jobe Orthopaedic Clinic (KJOC) and Constant's score were used to evaluate subjective and objective shoulder function. Results Mean follow-up was 7.9 years. Of the 135 patients, 120 (90%) returned to sports after surgery including 70 (52%) to the previous sport at the same level (RtS + outcome). By univariate analysis, the following factors were associated with an RtS + outcome: male sex, rotator cuff tear documented intra-operatively, absence of a greater tuberosity cyst on pre-operative imaging studies, and cuff tear debridement. Anterior capsulorrhaphy was associated with worse post-operative pain. Discussion The RtS + rate in this study differed from previously reported values, due to differences in the sports practiced by the patients and to considerable variability in the surgical techniques used. The positive association between presence of a rotator cuff tear and an RtS + outcome is at variance with most of the previously published data. Some of the apparent discrepancies between our results and those from other countries may be ascribable to differences in the most popular sports. Level of evidence IV.

Posterosuperior (or internal) impingement at the shoulder is defined as contact between the underside of the supraspinatus or infraspinatus tendons with the posterosuperior labrum during extreme external rotation and abduction. In many cases, this contact damages the tendon and causes mirror posterosuperior labrum deterioration. The primary aim of this study was to define whether this contact occurs normally in patients who do not have a rotator cuff tear. Methods We evaluated 100 shoulders in 100 patients. All patients were operated on in the beach chair position. After introducing the scope through the posterior portal, contact between the articular side of the rotator cuff and the posterosuperior labrum was noted as being present or absent when the arm was cocked in 90° abduction and 90° external rotation (90/90) then the arm was cocked in 140° abduction and maximum external rotation (140/Max). Results Contact was observed in 69% of patients in the 90/90 cocked position and in 94% of patients in the 140/Max cocked position. We found a correlation between the presence of rotator cuff and/or labrum lesions and the patient regularly performing arm-cock movements (p = 0.035). Discussion Contact between the underside of the supraspinatus tendon and the posterosuperior labrum occurs physiologically. Repetitive arm-cock movements may contribute to macroscopic lesions of the underside of the rotator cuff and posterosuperior labrum. Level of evidence IV, basic science study

Background No consensus exists about the management of massive and symptomatic rotator cuff tears (RCTs). The objective of this study was to compare the 12-month clinical outcomes of various treatment options for massive RCTs. Hypothesis Arthroscopic surgery has a role to play in the treatment of massive and apparently irreparable RCTs. Material and methods A prospective multicentre non-randomised study was performed in patients with massive RCTs managed non-operatively (NONOP) or by arthroscopic tenotomy/tenodesis of the long head of biceps (aTLB), arthroscopic partial tendon repair (aPTR), arthroscopic latissimus dorsi transfer (aLDT), or reverse shoulder arthroplasty (RSA). Clinical outcomes were evaluated based on the Constant score, Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) score after 3, 6, and 12 months. Results The 218 included patients (mean age, 69 years) were distributed as follows: NONOP, n = 71; aTLB, n = 26; aPTR, n = 61; aLDT, n = 25; and RSA, n = 35. After 12 months, the mean Constant score, SSV, and ASES score values were 70, 68%, and 73, respectively, and had improved significantly versus the preoperative values in all treatment groups. RSA was the only treatment followed by improvements in all Constant score items. Active forwards elevation improved significantly in the NONOP (+25°), aPTR (+26°), and RSA (+66°) groups. An improvement in active external rotation was seen only in the RSA group, where it was small (+10°, p = 0.046). Significant increases in internal rotation were seen in the NONOP (+1.6 points) and aPTR (+1.7 points) groups. Conclusion Arthroscopic techniques (aTLB, aPTR, and aLDT) for managing massive irreparable RCTs produce significant functional gains. Partial tendon repair (aPTR) and RSA may provide better outcomes than isolated aTLB or aLDT. Level of evidence III, non-randomised prospective study.

The mechanism of the boiling heat transfer in a falling film was studied experimentally in order to determine the cooling capacity of water in the DC casting. The experiments were based on the transient cooling technique. The quality (composition) of the water showed the strongest influence on transition between the different boiling regimes, on the character of the fluctuations of the surface temperature and heat flux.

Resume Hypothese Les ruptures du subscapulaire peuvent etre evoquees cliniquement devant une rotation externe passive augmentee en comparatif par rapport au cote oppose, des manœuvres de rotation interne contrariee (Lift-Off test [LOT], Belly-Press test [BPT], Napoleon test et Bear-Hug test [BHT]) et des signes de rappel automatique positifs (Internal Rotation Lag Sign et Belly-Off Sign). Le biceps est frequemment associe aux lesions du subscapulaire car ce dernier participe a la formation de la poulie mediale. Le Palm-Up test [PUT] est utilise pour le biceps comme le test de Jobe pour le supraepineux. Patients et methode Dans le cadre d’une etude multicentrique, nous avons souhaite evaluer la valeur diagnostique positive des tests cliniques LOT, BPT, BHT, PUT et de Jobe, pour les lesions du subscapulaire et leur importance anatomique. Les relations entre les differents parametres etudies ont ete comparees statistiquement en utilisant une analyse de la variance. Cette etude prospective multicentrique de janvier 2009 a fevrier 2010 comprenait 208 cas de lesions du subscapulaire isolees ou associees a une atteinte partielle (Ellman 1, 2, 3) ou transfixiante (stade 1 de la SFA) du supraepineux. Resultats La severite de l’atteinte du subscapulaire a ete quantifiee selon la classification de la SFA (en quatre stades) et selon la hauteur de l’atteinte (tiers proximal et tiers superieur). Les trois tests LOT, BPT et BHT etaient correles a severite des lesions observees (p Conclusion Malgre la realisation des trois tests (LOT, BPT, BHT), 24 % des lesions du subscapulaire n’etaient diagnostiquees qu’en peroperatoire. L’apport des signes de rappel automatique dans l’amelioration du diagnostic lesionnel n’a pas ete etudie dans ce travail. Niveau de preuve II.

Resume L’absence d’un systeme coherent de classification des lesions du sub-scapularis a rendu difficile la communication en matiere de traitement et de pronostic pour les differents types de rupture du sub-scapularis. En outre, une classification fiable fournit un moyen de comparaison des donnees epidemiologique et therapeutiques. Les classifications jusqu’alors proposees n’integraient pas les constatations radiologiques et peroperatoires de la coulisse du biceps et le degre de clivage du tendon du sub-scapulaire. Cette etude propose une nouvelle classification basee sur les constatations arthroscopiques a visee therapeutique et pronostic. Methode Il s’agit d’une etude prospective multicentrique promue par la Societe francaise d’arthroscopie de mars 2010 a janvier 2011. Cent cinquante cas de lesions isolees du sub-scapularis et d’atteinte anterosuperieure limitee ont ete etudies. La coulisse du biceps et l’insertion du feuillet profond du sub-scapularis ont ete explorees systematiquement par arthroscopie avec enregistrement video. Chaque lesion a ete classee par une analyse realisee par quatre chirurgiens et par convergence entre eux des conclusions lesionnelles. Resultats Quatre types lesionnels ont ete definis et sont bases sur les lesions constatees au niveau de la coulisse bicipitale. Le type I comprenait les lesions partielles de desinsertion des fibres du sub-scapularis de la petite tuberosite, sans lesion de la coulisse bicipitale. Le type II correspondait aux lesions partielles des fibres du sub-scapularis sur la petite tuberosite associees a une lesion partielle du mur anterieur de la coulisse bicipitale, mais avec conservation du ligament gleno-humeral superieur. Le type III correspondait a une desinsertion complete des fibres du sub-scapulaire de la petite tuberosite associee a une large fente de la coulisse bicipitale. Le stade IV correspondait a la desinsertion complete des fibres du sub-scapulaire, pouvant s’associer au « comma sign » par la reunion de fibres du sub-scapulaire et du supraepineux. Toutes les lesions constatees en peroperatoire pouvaient etre classees dans un de ces types a quelques exceptions pres. Discussion Une classification reproductible permet une description homogene des lesions entre les chirurgiens et a alors un interet therapeutique et/ou pronostique. Cette nouvelle classification permet de definir quatre types lesionnels facilement identifiables en cas de lesions du sub-scapularis isolee ou associee a une lesion antero-superieure de la coiffe des rotateurs. Cette classification peut etre completee en integrant des elements concernant la longue portion du biceps et l’infiltration graisseuse du muscle. Une etude de reproductibilite intra- et interobservateur reste necessaire pour completer la validation de son interet diagnostique ou pronostique. Niveau de preuve Niveau 2.

Resume Introduction Jusqu’a l’utilisation de l’arthroscopie dans la chirurgie de la coiffe des rotateurs, la frequence des lesions du subscapulaire est restee longtemps sous-estimee. Par ailleurs, leur traitement meme sous controle arthroscopique reste difficile. L’absence de classification reellement specifique des lesions du subscapulaire a rendu difficile la communication en matiere de traitement et de pronostic pour les differents types de rupture du sous-scapulaire. Le but de cette etude prospective multicentrique etait de valider la pertinence du traitement arthroscopique des lesions du subscapulaire en analysant les resultats a court terme, en fonction de l’importance initiale des lesions anatomiques. Methode Il s’agit d’une etude prospective multicentrique menee sous l’egide de la Societe francaise d’arthroscopie de mars 2010 a janvier 2011. Deux cent-huit cas de lesions isolees du subscapulaire ou associees a une d’atteinte antero-superieure limitee. Une evaluation des resultats cliniques (Score de Constant et University of California Los Angeles rating scale [UCLA]), anatomiques et du pronostic tenant compte de l’examen clinique, de l’imagerie pre- et postoperatoire et des lesions anatomiques mises en evidence a ete possible pour les donnees cliniques, sur un groupe de 103 patients ayant un recul d’un an et pour les donnees radiologiques, sur un groupe de 129 patients ayant au moins six mois de recul. Resultats Les resultats cliniques preliminaires portent sur 103 patients revus au recul minimal d’un an. Il existait une amelioration globale, statistiquement significative des scores de Constant et UCLA, avec dans ces cas une disparition des signes cliniques. Cette amelioration semblait augmenter avec le recul. Apres, classification en quatre groupes lesionnels des patients, en fonction des lesions anatomiques observees, il existait egalement une difference significative des resultats cliniques entre les differents types lesionnels. Les resultats anatomiques, apprecies par une imagerie postoperatoire chez tous les patients ayant au moins six mois de recul (n = 129) comportaient 92 % de cicatrisation tendineuse, mais associee dans 18,6 % a une amyotrophie de la partie superieur du subscapulaire et une majoration de l’infiltration graisseuse du corps musculaire. Discussion Notre etude confirme les bons resultats cliniques et radiologiques deja publies dans la litterature. L’utilisation d’une classification des lesions en quatre groupes a montre qu’elle etait utilisable des le bilan d’imagerie. Cette classification permettait surtout de differencier les resultats entre les types II et III. La tendance a l’amelioration des resultats avec le recul doit etre confirmee par une evaluation a plus long terme, de meme que l’absence de caractere pejoratif de l’aggravation de l’amyotrophie superieure du subscapulaire et de l’infiltration graisseuse. Niveau de preuve 3.

This study evaluated pre- and postoperative clinical and structural outcome data on anterosuperior rotator cuff tears involving the supraspinatus and subscapularis treated by arthroscopic methods. Between June 2006 and October 2007, a total of 155 consecutive patients underwent an arthroscopic repair for a supraspinatus or supraspinatus and infraspinatus (superior) rotator cuff tear. Of these, 44 (28%) were identified on preoperative imaging to have involvement of the subscapularis. Confirmation of subscapularis tears occurred during arthroscopic repair of the superior rotator cuff. If the subscapularis was found to be torn, it was documented, and an arthroscopic repair was performed. Postoperative clinical and radiographic outcomes were assessed with the belly press and lift-off tests, range of motion, strength, pain score, Constant score, and either a magnetic resonance imaging arthrogram or a computed tomography arthrogram at an average of 15 months postoperatively. Failure was determined based on rotator cuff integrity on radiologic studies. Sixteen of the 44 anterosuperior rotator cuff tears identified on preoperative imaging were found to have a full-thickness subscapularis tear requiring repair on arthroscopic examination. On preoperative imaging, subscapularis tears were all either grade 1 or grade 2 (no complete grade 3 tears). Mean follow-up was 16.9 months (range, 13–24 months). Compared with preoperative values, significant postoperative improvements occurred in Constant scores, forward flexion, strength, and pain scores ( P P

SummaryHypothesisClinically, subscapularis tendon tears are suggested by the presence of increased passive external rotation compared to the opposite side, resisted internal rotation manoeuvres (Lift-Off test [LOT], Belly-Press test [BPT], Napoleon test and Bear-Hug test [BHT] and positive Internal Rotation Lag Sign and/or Belly-Off Signs). Associated bicipital involvement is frequent with subscapularis tendon tears, because it participates in the formation of the biceps pulley. The Palm-Up test (PUT) is used for the biceps, and the Jobe test for the supraspinatus.Material and methodsIn this multicenter study, we evaluated the positive diagnostic value of the clinical tests, LOT, BPT, BHT, PUT, and the Jobe test for subscapularis tears as well as their anatomical value. The relationships of the different parameters studied were compared statistically by analysis of variance (ANOVA). This prospective multicenter study was performed from January 2009 to February 2010 and included 208 cases of subscapularis tendon tears, isolated or associated with partial (Ellman 1, 2 or 3) or full thickness (SFA stage 1) supraspinatus tears.ResultsThe severity of the subscapularis tear was quantified according to the SFA classification into four stages and according to the level of injury (the lower 1/3 and upper 2/3). The three tests LOT, BPT and BHT were correlated to the severity of observed tears (P

SummaryBackgroundUntil the introduction of arthroscopic-assisted surgery for rotator cuff repair, the frequency of subscapularis tears was underestimated. These tears remain challenging to treat even with arthroscopy. The absence of a specific classification system has hampered communication about the treatment and outcomes of the various types of subscapularis tears. The objective of this prospective multicentre study was to validate the relevance of arthroscopic subscapularis tendon repair based on an assessment of short-term outcomes according to the initial extent of the anatomic lesions.MethodsA prospective multicentre study sponsored by the French Society for Arthroscopy was conducted from March 2010 to January 2011 in 208 patients with subscapularis lesions that were either isolated or associated with limited anterosuperior tears. The Constant and UCLA scores were used to assess clinical outcomes. Anatomic and prognostic results were evaluated based on the physical examination, preoperative and postoperative imaging study findings, and anatomic lesions. Clinical data were available for 103 patients after at least 1year of follow-up and radiological data for 129 patients after at least 6months.ResultsThe preliminary clinical results in 103 patients with at least 1year of follow-up showed overall statistically significant improvements in the Constant and UCLA scores, with resolution of the clinical manifestations. The degree of improvement seemed to increase over time. The clinical results varied significantly across patient groups based on a classification system distinguishing four lesion types. Postoperative imaging studies to assess the anatomic results in all patients with at least 6months of follow-up (n=129) showed tendon healing in 92% of cases but also indicated muscle wasting of the upper subscapularis muscle in 18.6% of cases and increased fatty degeneration of the muscle belly.DiscussionOur study confirms the good clinical and radiological results reported in the literature. Our classification system distinguishing four lesion patterns was applicable during the imaging workup. The main finding from this classification system was the difference in results between Type 2 and Type 3 lesions. The trend towards improvements over time requires confirmation by longer-term studies, which will also have to establish that the increased wasting of the upper subscapularis muscle and fatty degeneration of the muscle belly have no adverse effects.Level of evidenceLevel 3.

Background: The arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair is growing in popularity. The current body of literature supports this technique; however, the number of patients in these studies is relatively small. The authors conducted this study to learn more about the natural history of this construct in a large sample of patients.Hypothesis: The double-row TOE rotator cuff repair will have an acceptable structural failure rate with improved clinical outcomes at 1-year follow-up.Study Design: Case series; Level of evidence, 4.Methods: Between June 2006 and October 2007, 225 patients underwent an all-arthroscopic rotator cuff repair at 2 surgical centers. A total of 155 TOE primary rotator cuff repairs were performed, and 154 of these patients met the inclusion criteria. Assessment of structural integrity was based on evaluation of postoperative magnetic resonance imaging or computed tomography arthrogram at a minimum of 12 months after surgery. The Constant scores, visual analog pain scale, range of motion, strength, and complications were the clinical outcomes analyzed for the study. Seventeen patients (of 154) had postoperative shoulder stiffness at follow-up.Results: The 154 patients were clinically and radiologically evaluated at a mean of 15 months postoperatively (range, 12-26.1 months). The study included 47 small (30.5%), 89 large (57.1%), and 19 massive (12.3%) rotator cuff tears. Analysis of postoperative imaging demonstrated that 92%, 83%, and 84% of the small, large, and massive rotator cuff tears, respectively, were intact. The mean Constant score improved from 44.42 points preoperatively to 80.47 points postoperatively ( P < .001). The mean preoperative pain score improved from 3.83 to 12.77 ( P < .001) postoperatively. The mean forward flexion improved from 123.06° preoperatively to 162.39° postoperatively ( P < .001). Seventeen patients (of 154) had postoperative shoulder stiffness at follow-up.Conclusion: The short-term results of this study indicate that the clinical outcomes and structural integrity of TOE double-row rotator cuff repair (the suture-bridge technique) have results that compare favorably with those reported for other double-row suture anchor techniques employed in rotator cuff repairs. Long-term follow-up will be necessary to determine if the durability of these repairs and the structural integrity of these constructs maintain their performance over time.

A high precision gravimetric method was used to investigate the adsorption of nitrogen (N2) and carbon tetrachloride (CCl4), respectively, at 77 and 298 K, onto various industrial minerals. The solids investigated include silica isomorphs, blast furnace slags, an Y-zeolite, and several naturally occurring fibrous minerals. The adsorption isotherms were analyzed to derive surface areas, BET constants (C), and surface fractal parameters (D). The latter were obtained through an approach recently suggested by Avnir and Jaroniec,1 using multilayer adsorption data; D values obtained for the various gas-solid systems investigated cover the range 2.1–3.0. A systematic comparison between D values inferred from N2 and CCl4 adsorption data shows that the CCl4 molecule probes the surface roughness in a more discriminate fashion than N2. In most cases, the differences between D(N2) and D(CCl4) appear to reflect changes due to sample preparation more than intrinsic differences amongst the various solids.

One hundred eighty pregnant patients, 17 to 39 years old (mean ± SEW 25.1 ± 0.39), with an amenorrhea of 7 to 12 weeks (mean ± SEW 9.4 ± 0.10), and requesting a therapeutic abortion, were selected according to general good health and gave their informed consent to the study. Mifepristone (RU-486; Roussel UCLAF, Paris, France) an antiprogestin steroid, was administered at random in doses of 0, 50, 100, 200, 400, or 600 mg. Clinical evaluations and measurements of cervical dilatation were done before the study and repeated at 24 hours after administration of Mifepristone and at 48 hours, at which time the aspiration was performed. Significant increases in cervical dilatation were observed at 48 hours with all doses of Mifepristone above 50 mg. The increases were significantly greater in patients with a gestational age 10 weeks' gestational age. Parity had no influence on cervical dilatation at 48 hours. Bleeding was observed significantly more often with 100 to 600 mg doses of Mifepristone than with 0 to 50 mg. No influence of gestational age or parity on bleeding could be detected. Abdominal cramps were reported more frequently with 200, 400, and 600 mg of Mifepristone at 48 hours and their occurrence appeared to parallel cervical dilatation. (AM J OBSTET GYNECOL 1990;162: 61-5.)

Adenocarcinoma of the urachus is a very rare disease. It often remains undiagnosed for a long time and has an aggressive course. Surgery, the only potentially curative treatment, was initially very extensive, but this attitude has been revised more recently. The authors present three clinical cases, and discuss the treatment options. The first two cases were treated by one-stage resection and the third case, which presented with a mucus collection in the abdomen with "signet ring" cells, was treated by Intraperitoneal ChemoHyperthermia (IPCH) during second-look laparotomy. A review of the literature shows that the current tendency is towards less mutilating surgery. Diagnostic examinations, allowing earlier detection of this disease, may possibly alter its prognosis, which was considered to be very poor up until recently.

The reaction of chromate and ascorbate in a 1:1 molar ratio at pH 7.4 and 37 degrees C produces a Cr(V) signal observable by EPR at g = 1.980. When this reaction is carried out in aerated media and in the presence of formate, carboxylate radicals (COO.-) can be trapped as DMPO-COO.- spin adducts (DMPO, 5,5-dimethyl-1-pyrroline N-oxide). The use of a known complexant of Cr(V), 2-ethyl-2-hydroxybutyric acid, produces a different Cr(V) signal at g = 1.978 and a decrease of the DMPO-COO.- signal. Hydroxyl radicals are not detected in the media. The oxidizing behavior is suggested to be produced by activation of molecular oxygen present in the reaction mixture.

The reactions of various chromate pigments and ascorbate were investigated by an ESR spin trapping technique. Production of Cr(V) was detected directly and productions of very electrophilic reactive oxygen species (ROS) was detected via the oxidation of formate. We demonstrated previously that both dissolved oxygen and Cr (V) were essential in the production of ROS in this system, and that ROS production was inhibited by catalase. We studied here the effect of solubility of different chromate pigments: sodium, calcium, strontium, basic zinc, basic lead supported on silica, and lead and barium chromates on the production of ROS in buffered medium and cell culture medium (Dublecco's Modified Eagle medium + fetal calf serum). Sodium, calcium, basic zinc, and basic lead chromates were active in the production of ROS in presence of cell culture medium, whereas lead and barium chromates were inactive.

There has been numerous attempts to link the ATP content of activated sludge to certain wastewater characteristics or to certain control parameters used in the operation of wastewater treatment plants. Published results vary and result from the use of different ATP extraction and measurement methods. This study deals with the development of an analytical method that requires filtration on polycarbonate membrane (0.4 μm) and a subsequent ATP extraction with DMSO. The filtration step overcomes problems of enzymatic inhibition in the firefly bioluminescence assay due to dissolved substances in the liquid fraction of the activated sludge samples. In comparison with extraction in boiling TRIS buffer, the most widely used method, extraction in DMSO was found to be effective and advantageous owing to its simplicity and reliability, the ease of its execution, and its potential use in routine measurements. The application of this analytical procedure to aerobic sludges in batch culture yielded a higher estimate of the average value of the ATP pool than previously published results.

Conditioned medium from human placental monolayer cultures (PM) had a marked stimulatory effect on proliferation (3H-thymidine uptake) of human fetal zone adrenal cells in primary monolayer culture, even in the absence of serum. Epidermal growth factor (EGF) and fibroblast growth factor (FGF) also significantly stimulated fetal adrenal cell growth. However, the effects of PM differed from those of EGF and FGF in several respects: 1) maximal response to PM was 2-5 times greater; 2) mitogenic effects of EGF and FGF were suppressed by adrenocorticotropic hormone (ACTH), whereas that of 50% PM was not; 3) PM inhibited ACTH-stimulated steroidogenesis (dehydroepiandrosterone sulfate and cortisol), but EGF and FGF did not. Preliminary characterization studies have indicated that approximately half of the placental growth-promoting activity is heat resistant and sensitive to bacterial proteases, and that 50-60% of the activity is lost after dialysis with membranes having a molecular weight cutoff of 3500. These findings suggest a role for the placenta in the growth and differentiated function of the human fetal adrenal gland.

This study fits into the scheme of research work being carried out to control stormwater rejects. Its main objective is to represent, with the help of a water quality index, the deterioration of the quality of the Saint-Charles River, caused by the combined sewer overflows of Quebec City, Canada, during a rainstorm. The proposed quality index has been applied to evaluate the recreational use of the river.The overall results obtained in the case of a 20 mm rain show index values that characterize a water of poor quality. Moreover, within the region of the combined sewer overflow, a minimum delay of 24 h is necessary to allow the water quality of the Saint-Charles River to return to the level where it was at the dry period, which generally has a value less than the critical value for recreative use. Key words: water quality index, urban runoff, water pollution, nonpoint source of pollution, water quality, water use, environmental impact, pollution control.

A study, by vapor phase chromatography, of the adsorption isotherms of benzene on raw and modified asbestos fibers as well as on fibers proposed as substitutes for asbestos shows that there is a marked difference in the behaviour of the various fibers examined. A comparison of the adsorbing power of raw and phosphorylated asbestos fibers, as well as asbestos fibers heated to 700 °C, has been made regarding their behaviour toward solutes bearing various functional groups, and it has shown the existence of physical adsorption as well as chemisorption. The presence of hydroxyl groups in the surface of the asbestos fibers favors the adsorption of organic molecules through hydrogen bonding. [Journal translation]

During the last 20 months, 518 patients were included in a cooperative and comparative study of the use of two T-Cu and Lippes loop intrauterine contraceptive devices. In our own group, 60 Lippes loop devices, 168 T-Cu devices of 120 mm. 2 and 250 T-Cu devices of 200 mm. 2 were inserted. The total months of use in each group were 1,021 for the Lippes loop, 2,442 for the 120 mm. 2 T-Cu, and 1,504 for the 200 mm. 2 T-Cu. The insertion of the T-Cu is easier than that of the Lippes loop, and the percentage of events such as spotting, dysmenorrhea, and metrorrhagia are lower with the T-Cu. The rate of expulsion is higher for the 200 mm. 2 T-Cu than for the 120 mm. 2 T-Cu, but all the remaining types of termination were the highest for the 120 mm. 2 T-Cu. The termination rate is 19.66 for the Lippes loop, 32.03 for the 120 mm. 2 T-Cu, and 24.17 for the 200 mm. 2 T-Cu. The T device produced less secondary effects than the loop.

Summary Background The absence of a coherent classification system has hampered communication about the treatment and outcomes of the various types of subscapularis tendon lesions. In addition, a reliable classification system allows comparisons of epidemiological and therapeutic data. The classification systems used until now fail to incorporate the radiological and intraoperative abnormalities of the bicipital sling, and they do not consider the degree of subscapularis tendon cleavage. Here, we describe a new arthroscopy-based classification system intended for therapeutic and prognostic purposes. Methods A prospective multicentre study sponsored by the French Society for Arthroscopy was conducted from March 2010 to January 2011 in 150 isolated subscapularis lesions with or without limited anterosuperior involvement. The bicipital sling and insertion of the deep subscapularis layer were routinely investigated by arthroscopy with video recording. Each lesion was classified after a consensus was reached among four surgeons. Results We identified four lesion types based on the bicipital sling findings. Type I was defined as partial separation of the subscapularis tendon fibres from the lesser tuberosity with a normal bicipital sling. Type II consisted of a partial subscapularis tear at the lesser tuberosity attachment combined with partial injury to the anterior wall of the bicipital sling, without injury to the superior glenohumeral ligament. Type III was complete separation of the subscapularis fibres from the lesser tuberosity with extensive cleavage of the bicipital sling. Finally, in Type IV, all the subscapularis fibres were detached and, in some cases, conjunction of the subscapularis and supraspinatus fibres produced the comma sign. Nearly all the lesions identified intraoperatively during the study fit one of these four types. Discussion A reproducible classification system that allows different surgeons to establish comparable homogeneous patient groups is useful for both therapeutic and prognostic purposes. We defined four types of subscapularis lesions that are easy to identify as either isolated lesions or combined with anterosuperior rotator cuff tears. Long head of biceps tendon abnormalities and fatty degeneration of the shoulder muscles can be added to our classification system. Studies of intraobserver and interobserver reproducibility are needed to complete the process of validating the diagnostic and/or prognostic usefulness of this new classification scheme. Level of evidence II.

Studies of human fetal adrenal function and its control have revolved mainly around the remarkable capacity of the unique fetal zone of this gland to elaborate dehydroepiandrosterone sulfate. Another important function of the fetal adrenal, however, is its production of cortisol. Because the human fetal adrenal is deficient in 3β-hydroxysteroid dehydrogenase activity, cortisol has been thought to be formed from circulating progesterone. To further investigate this hypothesis, cortisol production by separated fetal and definitive zones of the midgestation human fetal adrenal in organ culture has been examined in the absence and presence of varying concentrations of progesterone and adrenocorticotropic hormone. Cortisol was measured by radioimmunoassay. In the absence of progesterone, cortisol production by both zones increased gradually over time in culture in response to adrenocorticotropic hormone. In the presence of progesterone, cortisol production by the definitive zone was unchanged. In contrast, the response of the fetal zone to progesterone was immediate: cortisol production increased significantly and remained high throughout the culture period. These results suggest a greater capacity of the fetal zone to utilize progesterone for cortisol production and are consistent with morphologic evidence that the active zone of the midgestation human fetal adrenal is the fetal zone, possessing not only the enzyme activity necessary for dehydroepiandrosterone sulfate production but, except for 3β-hydroxysteroid dehydrogenase, that for cortisol production as well.

A single intra-amniotic injection of 500 mg. of hydrocortisone sodium succinate was done 48 hours before elective cesarean section in nine patients in week 39 of gestation. Following that single injection, estriol values fell in all three compartments. Cortisol was rapidly increased in the maternal compartment but returned to normal levels at the time of cesarean section in maternal and umbilical vein cord plasma while remaining elevated in the amniotic compartment. Progesterone was increased in the fetal and amniotic compartments but remained essentially unchanged in the maternal compartment. The foam test was constantly improved in the direction of an intermediary or positive test and the quantitative lecithin-sphingomyelin values were increased by almost twofold. In our series, none of our babies developed a respiratory distress syndrome nor had any difficulty with the first breath or the Apgar score. We did not deliver any low-birth-weight infants and the creatinine values were even improved by our injection.

We established for human fetal liver cells (cultured for 2 wk) in a hormonally defined medium, optimal conditions for attachment, multiplication, and preservation of epithelial morphology as well as production and secretion of serum proteins characteristic of fetal (alpha l-fetoprotein, AFP) and adult (albumin and hemopexin) life. Conditions were considered optimal when cell number, albumin, and hemopexin levels were maintained throughout the 2-wk culture period. However, the decrease in AFP concentration, which occurred after a few days of culture, could not be reversed. The culture system developed is a suitable model for studying regulatory mechanisms governing structure and function during differentiation and may prove useful for testing the effect of toxic agents during fetal development of the human liver.

To determine the direct effects of insulin-like growth factors (IGFs) on hormone release by the human pituitary gland, human foetal, adult normal and tumour pituitary tissues were maintained in culture for 2 to 4 weeks and tested with acute (3 h) exposures to different preparations of IGF peptides. Adult normal pituitaries and adenomas were tested with a semipurified preparation of IGFs, free of immunoreactive insulin, containing IGF-I and IGF-II in a ratio of approximately 1:4. Human foetal pituitaries were tested with the semipurified IGFs as well as more purified preparations of IGF-I and IGF-II. Culture media were assayed for hGH, hPrl, hACTH and hLH using specific radioimmunoassays. Both foetal (n = 16 (No. of pituitaries), 33 (No. of observations)) and normal adult (n = 3, 16) human pituitaries cultures responded to the semipurified IGFs (2–25 ngEq/ml for foetal and 2–4 ngEq/ml for adult pituitaries) with a significant decrease in hGH release compared to basal (P < 0.01) whereas the GH-secreting pituitary tumours showed no effect when tested with from 2 to 25 ngEq/ml (n = 8, 129, ns). The effect of IGFs on human foetal somatotrope activity was dose-related for both the semipurified IGFs (2–25 ngEq/ml, n = 16, 33) and IGF-I or IGF-II (10–100 ng/ml; n = 3, 18). hPrl release was inhibited in the normal adult (n = 2, 12; P < 0.01) but not in the foetal (n = 2, 9; ns) pituitary cultures by 2–4 ngEq/ml of the semipurified IGFs, while the Prl-secreting pituitary tumour cultures showed variable responses to 3–4 ngEq/ml of the same IGFs preparation (a) suppression: n = 1, 14, P < 0.001; b) no effect: n = 3, 28, ns). hGH release was inhibited in one of the two mixed (GH- and Prl-secreting) tumours examined (n = 1, 10, P < 0.02) and unaffected in the other (n = 1, 14, ns), while hPrl release remained unchanged in both. The IGFs did not alter release of hLH or hACTH by either foetal or normal adult pituitaries. Conclusions: A semipurified preparation of IGFs directly inhibited hGH release by human foetal pituitaries and hGH and hPrl release by normal adult pituitaries but had no effect on hLH or hACTH secretion. Human foetal somatotropes responded to IGF-I and IGF-II in a similar dose-dependent manner suggesting that, like in the rat, both IGF peptides can have an inhibitory influence on GH secretion. GH- and/or Prl-secreting pituitary adenomas showed a predominant lack of responsiveness to the semipurified IGFs, suggesting that the sensitivity of somatotropes and lactotropes to an IGF inhibitory influence is often abnormal in the tumour state.

The rate and rapidity of albumin transferred through human Fallopian tubes were measured in vitro in certain clinical circumstances. Both “absorption” and “excretion” types of transfer were carried out simultaneously. The rapidity of maximal transfer is greater in the “absorption” than in the “excretion” studies and also greater in the combined oral contraceptive, postpartum, and early and late luteal phase groups than in the early and late follicular phase groups. The possible contribution of the experimental design and the effect of progesterone on the rapidity of transfer is discussed. More albumin is “absorbed” than “excreted”. This excess is greater in the early luteal and late follicular phases and in the contraceptive pill users. The lower excesses found in term pregnancy and immediately post partum are explained on the basis of morphologic and physiologic changes and also by the experimental design. The possible contribution of estrogens in enhancing the amount of albumin “absorbed” is discussed.

Metronidazole (Flagyl), an investigational drug, was administered by mouth to more than 300 patients with trichomoniasis. At least 203 of these patients were cured by a single course of treatment, the drug being administered as one 250-mg tablet with each of three meals daily for 10 days. At this dosage, no adverse neurological reactions were observed; urinary complications, including the urinary pigmentation reported by others, did not occur in this series, and the only hematological effects were transient changes in the white blood cell counts. Of 21 patients who were not cured by the first course, 11 were cured by a second and 5 by a third course; 5 remained carriers and, though free from symptoms, were kept under observation. The authors advise against use of the drug during pregnancy and against treatment of the husband unless an examination indicates the need for therapy.