Surgical synovectomy in haemophilic arthropathy of the knee

Summary Twenty seven patients with haemophilia who had repeated haemarthroses affecting the knee joint, despite appropriate substitution therapy, were treated by surgical synovectomy. Open operations were carried out on 18 and 9 had an arthroscopic procedure. The average age at the time of synovectomy was 13 years for both the open and arthroscopic groups. The open group was followed up for an average of 15.2 years and the closed for 5.4 years. Operation took 70 minutes on average in the arthroscopic group and 50 minutes in the open. Patients who had an arthroscopy were in hospital for an average of 5 days and those with an open operation for 10. Synovectomy by both methods significantly reduced bleeding episodes. The results were assessed according to the classification recommended by the Orthopaedic Advisory Committee of the World Federation of Haemophilia. In the open group 2 patients had a good result, 10 were fair and 6 poor; in the arthroscopic group 3 had a good result, 5 were fair and 1 poor. Both operations appeared to slow, but did not halt, the radiographic deterioration of the joints.

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Résumé Vingt-sept hémophiles qui présentaient des hémarthroses récidivantes du genou en dépit d'une thérapeutique substitutive appropriée ont été traités par synovectomie chirurgicale, 18 à ciel ouvert et 9 par arthroscopie. L'âge moyen des malades au moment de l'opération était de 13 ans dans les deux groupes, le recul moyen des observations est de 15,2 ans dans le groupe opéré à ciel ouvert et de 5,4 ans dans l'autre, la durée de l'opération a été de 70 minutes dans le groupe arthroscopique et de 50 minutes dans l'autre, l'hospitalisation a été de 5 jours dans le groupe arthroscopique et de dix jours dans l'autre. Les deux techniques ont obtenu la diminution des épisodes hémorragiques. Les résultats ont été évalués selon la cotation du «Comité orthopédique consultatif de la Fédération mondiale de l'Hémophilie»: 2 sont bons, 10 médiocres et 6 mauvais dans le groupe opéré à ciel ouvert et 3 bons, 5 médiocres et 1 mauvais dans le groupe arthroscopique. Ces résultats montrent que les deux techniques peuvent ralentir la détérioration du genou, mais non l'interrompre.

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Deceased     

Nonpuerperal breast infection

Objective: We undertook a microbiological study of purulent specimens from women with symptomatic breast abscesses.Methods: Fifty-one purulent samples were collected in 2 periods (December 1991-April 1992 and January 1994-June 1994) from nonpuerperal breast abscesses in 44 patients attending our hospital.Results: One of the most frequently isolated microorganisms was Proteus mirabilis (9 patients, 20.4%), present as a pure culture in all but 1 specimen (isolated together with Peptostreptococcus spp.). Staphylococcus aureus was isolated in 10 specimens, 6 of which were post-tumorectomy abscesses. Polymicrobial anaerobic flora were isolated in 11 specimens (21.5%); Staphylococcus epidermidis in 4 (8%); and Streptococcus milleri,Alcaligenes sp., and mixed aerobic-anaerobic flora in 1 specimen each. The 7 remaining samples (13.7%) were negative bacteriological cultures.Conclusions: We draw attention to the frequent isolation of P. mirabilis in recurrent and torpid breast abscesses in 4 women in whom surgery was necessary in addition to antibiotic treatment.     

S-laminin and N-acetylgalactosamine located at the synaptic basal lamina of skeletal muscle are involved in synaptic recognition by growing neurites

Summary The purpose of the work reported here is to identify molecular components of the synaptic basal lamina of skeletal muscle fibres which allow recognition of original synaptic sites by regenerating motor axons. We focused on s-larninin and components recognized by the lectinDolichos biflorus agglutinin previously shown to be specifically located at the synaptic basal lamina. We used a cryoculture bioassay in which chick ciliary ganglion neurons grow on rat skeletal muscle cryostat sections. In control cultures, neurites extended over the muscle sections in close association with the muscle cell surface. It was observed that most of the neurites that extended towards the endplate zone and reached an area of 40 m around the neuromuscular junction ceased to grow when they contacted the synaptic site. Masking either lectin receptors or some s-laminin molecule epitopes prior to the culture of neurons alters the behaviour of growing neurites. On sections treated either withDolichos biflorus agglutinin or anti s-laminin monoclonal antibodies (D5 and C4) most of the neurites did not stop their growth at the synaptic regions. Moreover, treating muscle sections withDolichos biflorus agglutinin removed the gradient of substratum affinity around the endplate. These results indicate that the s-laminin andDolichos biflorus agglutinin receptors present on muscle cell surfaces may play a functional role in the interaction of growing neurites with original synaptic sites in the process of neuromuscular regeneration.     

Organization of visual cortex in the northern quoll, Dasyurus hallucatus: evidence for a homologue of the second visual area in marsupials

Two visual areas, V1 and V2 (first and second visual areas), appear to be present in the posterior neocortex of all eutherian mammals investigated so far. However, previous studies have not established whether an area homologous to V2 also exists in metatherian mammals (marsupials). Using electrophysiological techniques, we mapped the visual receptive fields of neurons in the striate and peristriate cortices of the northern quoll, an Australian marsupial. We found that neurons in a 2-mm-wide strip of cortex rostrolateral to V1 form a single, relatively simple representation of the complete contralateral hemifield. This area resembles V2 of eutherians in several respects: (i) neurons in the medial half of the peristriate area represent the lower visual quadrant, whereas those in the lateral half represent the upper visual quadrant; (ii) the vertical meridian of the visual field is represented adjacent to V1, while the visual field periphery is represented along the lateral and rostrolateral borders of the peristriate area; (iii) there is a marked anisotropy in the representation, with a larger magnification factor parallel to the V1 border than perpendicular to this border; and (iv) receptive fields of multiunit clusters in the peristriate cortex are much larger than those of cells in V1 at comparable eccentricities. The cortex immediately rostral and lateral to V2 did not respond to visual stimulation under our recording conditions. These results suggest that V1 and V2 together form a 'core' of homologous visual areas, likely to exist in all therian mammals.     

Tuberous breast syndrome. Report on a series of 22 operated patients

The tuberous breast syndrome is a rare unilateral or bilateral breast malformation presenting at the age of mammary development. It requires surgical correction, depending on the severity of the clinical expression, because of its inaesthetic appearance. We report a series of 22 patients (35 breasts) treated and followed up in the plastic and reconstructive surgery department of Rennes over a period of nearly ten years. The average age was 18 +/- 3.2 years (range: 15-26 years old). Long-term results were assessed by the surgical team and the patients on the basis of objective and subjective criteria with an average follow-up of 36 months (12 to 116 months). In our opinion, surgical correction should be proposed after puberty with, whenever possible, section of the basal fibrous ring and glandular plasty via a periareolar incision. The use of mammary implant alone or in combination with breast tissue remodelling must be reserved for hypoplastic cases only.     

Immunohistochemical localization of a choriogonadotropin-like protein in bacteria isolated from cancer patients.

By the use of specific antibody to human chorionic gonadotropin (CG) as well as to its beta-subunit, and the application of the indirect fluorescein-labeled and peroxidase-labeled antibody techniques, we have demonstrated the presence of a membrane (wall)-associated CG-similar immunoreactive protein in 15 strains of bacteria isolated from tissues of patients bearing malignant neoplasms. These microorganisms were classified as S. epidermidis, (12) E. coli (2), and a single strain of P. maltophilia (ATCC 13637). The absence of the CG-like antigen in other "cancer associated bacteria", Streptococcus faecalis (ATCC 12818) and Pseudomonas aeruginosa (from patient with cancer of colon), demonstrated that not every "cancer associated bacteria" has the capability to synthesize the trophoblastic-like protein. The negative results obtained with a number of "noncancer control" bacteria of known origin, obtained from ATCC and from clinical samples, strongly supported the idea that the existance of these CG-like protein producing microorganisms is not a ubiquitous finding. The demonstration of a de novo bacterial biosynthesis of a protein having similar antigenic and biophysical properties to those of the human trophoblastic hormone, has great biological implications, especially if its biosynthesis is proven only in bacterial strains growing in the presence of cancer cells in which we have already demonstrated the presence of a similar antigen. The explanation of the phenomenon is unknown. Because of their origin, the potential of "genetic exchange" with subsequent expression of the mammalian gene by the bacterial cells becomes a possibility. It is also possible that the gene coding for the CG-like protein is normally present but inactive or repressed in all bacteria.     

Aspiration syndrome in cesarean section. Our experience from 1980 to 1990]

In the last twenty years maternal mortality attributed to anaesthesia has decreased. Inhalation of gastric contents is the commonest cause in patients undergoing cesarean section; in fact pregnant women are considered "high risk" because of gravidic modifications. In this retrospective study of 10017 caesarean sections performed under general anaesthesia in our institution between January 1980 and December 1990, we evaluated the frequency of this syndrome (7 cases = 1:1431). We had no case of maternal and neonatal mortality. All these seven patients were admitted at our recovery room for less than 5 days; aspiration pneumonitis occurred in only three patients. Our results suggested that induction of anaesthesia with high doses of thiopental reduces complications related to light anaesthesia, including vomiting. At a dose of 5-6 mg/kg thiopental didn't produce any significant neonatal depression as documented by Apgar scores.