Value of a percutaneous estrogen solution in stopping lactation

An open trial involving 121 women was carried out to compare the efficacy and safety of a percutaneous estrogen solution and of an anti-prolactin solution. The complete inhibition of the let-down of milk was slightly less frequently obtained with the Percutacrine Oestrogénique that with Parlodel. The efficacy of Percutacrine Oestrogénique was linked to two conditions of administration: administration soon after delivery and compliance with the dosage, which was less frequently achieved than with Parlodel. In contrast, the clinical safety of Percutacrine Oestrogénique was excellent, and significantly better than that of Parlodel, notably with regard to dizziness (p less than 0.001 for the first 5 days of treatment). The incidence of the depressive tendency commonly observed post-partum was lower in the group of women receiving Percutacrine Oestrogénique, and reached the level of significance after 10 days of treatment.     

Prenatal spontaneous closure of gastroschisis: a paradoxal evolution with poor outcome

Usually considered as an isolated malformation carrying a rather good postnatal prognosis, gastroschisis may however occasionally bear an unfavourable outcome despite reassuring ultrasound follow-up. We report on the case of a fetus with gastroschisis diagnosed at 13 weeks of gestation followed by a progressive bowel absorption and closure of the abdominal defect at 24 weeks, associated with a 10 to 15mm intra-abdominal bowel tract dilatation. At birth, the infant did not show any recognizable ventral wall defect or scar. Surgical exploration was decided due to the presence of a high level bowel tract occlusion associated with a dilated proximal jejunum on standard abdominal X-ray radiograph. Long-segment atresia of the midintestine without any possible surgical option was observed. The infant died at day 5.     

Impact of graft mass on the clinical outcome of kidney transplants

The effect of nephronic mass reduction of kidney transplants has not been analyzed specifically in a large cohort. Transplant injuries in cadaver kidney graft may have led to an underestimation of the magnitude of this factor. The aim of this study was to analyze the consequences of kidney mass reduction on transplantation outcome. The weights of 1142 kidney grafts were collected prospectively immediately before grafting. Donors and recipients <15 yr of age, simultaneous kidney/pancreas grafts, and technical failures before day 7 were excluded from the analysis. The analysis was performed on Cockroft-calculated creatinine clearance and proteinuria in 964 patients for whom all of the necessary information was available. This study reports that the smallest kidneys transplanted into the largest recipients (donor kidney weight/recipient body weight [DKW/RBW] <2 g/kg, n = 88) increased their clearance by 2.38 ml/min every month for 6 mo (P < 0.0001) and by 0.27 ml/min thereafter (P < 0.0001). Conversely, creatinine clearance did not change for the largest kidneys transplanted into the smallest recipients (DKW/RBW ratios >/=4 g/kg). Next, using a Cox model analysis, it was shown that the risk of having a proteinuria >0.5 g/kg was significantly increased for the low DKW/RBW ratios <2 g/kg with 50% of patients having a proteinuria, compared with DKW/RBW ratios >/=4 g/kg (P < 0.001). In cadaver transplant recipients, graft mass has a rapid impact on graft filtration rate and proteinuria. Avoiding major kidney/recipient inadequacy should have a significant influence on long-term transplant function.     

Neural correlates of implicit object identification

The present study sought to assess neural correlates of implicit identification of objects by means of fMRI, using tasks that require matching of the physical properties of objects. Behavioural data suggests that there is automatic access to object identity when observers attend to a physical property of the form of an object (e.g. the object's orientation) and no evidence for semantic processing when subjects attend to colour. We evaluated whether, in addition to neural areas associated with decisions to specific perceptual properties, areas associated with access to semantic information were activated when tasks demanded processing of the global configuration of pictures. We used two perceptual matching tasks based on the global orientation or on the colour of line drawings. Our results confirmed behavioural data. Activations in the inferior occipital cortex, fusiform and inferior temporal gyri in both tasks (orientation and colour) account for perceptual and structural processing involved in each task. In contrast, activations in the posterior and medial parts of the fusiform gyrus, shown to be involved in explicit semantic judgements, were more pronounced in the orientation-matching task, suggesting that semantic information from the pictures is processed in an implicit way even when not required by the task. Thus, this study suggests that cortical regions usually involved in explicit semantic processing are also activated when implicit processing of objects occurs.     

Reconstruction after traumatic destruction of the finger joints

Miniaturized osteosynthesis still is the best solution for articular injuries, but in case of destruction the indications will depend on several patient-linked factors (age, handedness, profession...) and on the loss of substance. In case of limited loss of substance, Swanson's prosthesis provided an average mobility of 48 degrees at the MP level and 34 degrees at the PIP level. In case of extensive osteoarticular loss, only island or free vascularized articular transfer allow avoiding arthrodesis. The transfers provided mobility exceeding 45 degrees at the MP level and 42 degrees at the PIP level, therefore better values than with free articular toe transfers (35 degrees for the MP joints and 23 degrees for the PIP joints).     

La microchirurgie en traumatologie de la main

Résumé La microchirurgie apporte un progrès important au traitement primaire des plaies des mains. La microsuture des tendons fléchisseurs (Kleinert), la revascularisation par réparations artérielles et veineuses, la suture fasciculaire des nerfs sont des techniques fiables qui favorisent la cicatrisation et la récupération fonctionnelle, pourvu que la mobilisation précoce soit mise en oeuvre dans toute la mesure du possible et du raisonnable.

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Microsurgery in acute treatment of hand injuries

Summary Microsurgery has brought important progress in the primary treatment of wounds of the hand. Microsuture of flexor tendons (Kleinert), revascularization by arterial and venous repair and bundle suture of nerves are all proven techniques which favour healing and functional recovery, provided early mobilization is instituted whenever possible.

Présenté au Congrès de la SICOT à Kyoto — Octobre 1978     

Radiographic views in hand surgery

Numerous radiographic views are available for visualisation of the squeleton of the hand. After an analysis of the literature, the authors selected those approaches which are simple and yield the best results.