Influence of the level of arterial resection on the replanting and revascularization results in hand surgery: prospective study over 22 months

The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.

The development of the dog heartworm is highly sensitive to sterols which activate the orthologue of the nuclear receptor DAF-12

Prevention therapy against Dirofilaria immitis in companion animals is currently threatened by the emergence of isolates resistant to macrocyclic lactone anthelmintics. Understanding the control over developmental processes in D. immitis is important for elucidating new approaches to heartworm control. The nuclear receptor DAF-12 plays a role in the entry and exit of dauer stage in Caenorhabditis elegans and in the development of free-living infective third-stage larvae (iL3) of some Clade IV and V parasitic nematodes. We identified a DAF-12 ortholog in the clade III nematode D. immitis and found that it exhibited a much higher affinity for dafachronic acids than described with other nematode DAF-12 investigated so far. We also modelled the DimDAF-12 structure and characterized the residues involved with DA binding. Moreover, we showed that cholesterol derivatives impacted the molting process from the iL3 to the fourth-stage larvae. Since D. immitis is unable to synthesize cholesterol and only completes its development upon host infection, we hypothesize that host environment contributes to its further molting inside the host vertebrate. Our discovery contributes to a better understanding of the developmental checkpoints of D. immitis and offers new perspectives for the development of novel therapies against filarial infections.

Venous leiomyosarcoma arising from the radiocephalic vein

Vascular leiomyosarcoma is a very rare soft tissue neoplasma. We are reporting a vascular leiomyosarcoma case arising from an unusual site: the radiocephalic vein. Despite a poor prognosis, after surgery and radiotherapy, the patient was alive without signs of recurrence two years later.

Superior sternoclavicular dislocation: A case report

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Functionnal treatment is commonly used for anterior Sternoclavicular dislocations, and surgery for posterior disclocations.

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Superior Sternoclavicular dislocations are very rare.

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A functionnal treatment can be used without complications.

Introduction

Sternoclavicular dislocations are difficult to diagnose and often missed.

Anterior dislocations are more common than posterior dislocations and typically have a low risk of complications.

Presentation of case

We report the third case of post-traumatic superior sternoclavicular dislocation, which was successfully treated by functional treatment.

Discussion

The sternoclavicular joint is a diarthrodial joint with three degrees of freedom that is relatively immobile and incongruent.

The treatment strategy for these injuries is based on two criteria: the possibility of vascular, nerve or tracheal compression such as in posterior dislocations, which is a surgical indication because of potential risk to life and function; the second indication is to improve esthetics, which is especially a concern with anterior dislocations.

Conclusion

Superior sternoclavicular dislocation is a rare condition, with only three published cases up to now. Functional treatment can be used without complications.

[Treatment of extra-articular distal radius fractures in active elderly patients]

Extra-articular distal radius fractures in active elderly patients are common and predominantly affect females. The high number of patients lost to follow-up compromises the evaluation of outcomes. Treatment aims to control the comminution and allow fast recovery of pre-injury activity levels. Fixation with volar locking plates is the gold standard. The role of bone substitutes in this type of injury is unclear.

[Temporary vena caval filters: report on cohort of 72 patients in Grenoble, France]

Patients with a contra-indication for anticoagulation can benefit from temporary vena caval filters for protection against pulmonary embolism or recurrence. The filter can be removed secondarily, once the contra-indication is overcome, enabling better long-term outcome by reducing the risk of thrombotic and mechanic complications inherent in these devices. However, it has been shown in several studies that effective withdrawal rates were low and could be improved by the establishment of protocols and registries. We report a retrospective study of withdrawal in 72 patients in whom an ALN® vena caval filter was implanted at the Grenoble University Hospital over a period of three years with an intention for secondary retrieval. Seventy percent of the indications were related to the coexistence of thrombotic and hemorrhagic conditions. Fifty-five percent of filters were removed, the remaining 45% shared involved patients who died before retrieval (11%), those lost to follow-up (4%), technical failure of retrieval (6%), withdrawal technically unfeasible (3%), retrieval refused by patients (6%) and medical indications for continuing filtration (15%). Despite an effective follow-up of these patients and 91% success rate of withdrawal, nearly one out of two filters remains in place. A long-term follow-up of these patients is needed to learn more about the outcome of these filters.

Modulation of intestinal barrier properties by miltefosine

Miltefosine (hexadecylphosphocholine, HePC) is the first effective oral agent for the treatment of visceral leishmaniasis. This study aimed to determine whether this oral administration alters the integrity and transport capacities of the intestinal barrier. The objectives of this study were: (i) to evaluate the cytotoxicity of HePC, (ii) to investigate the effects of HePC on paracellular and transcellular transport and (iii) to investigate the influence of HePC on three major transporters of the intestinal barrier, namely, P-glycoprotein, the human intestinal peptide transporter (PepT-1) and the monocarboxylic acid transporter (MCT-1) in Caco-2 cell monolayers, used as an in vitro model of the human intestinal barrier. We show that HePC reduced the transepithelial electrical resistance and increased D-[14C]mannitol permeability in a dose-dependent manner but had no effect on [3H]testosterone permeability, demonstrating that HePC treatment enhances paracellular permeability via an opening of the tight junction complex without affecting the transcellular route. Morphological studies using confocal fluorescence microscopy showed no perturbation of the normal distribution of ZO-1, occludin or E-cadherin but revealed a redistribution of the tight junction-associated protein claudin-1 and the perijunctional actin after incubation with HePC. Finally, HePC was found to inhibit the intestinal P-glycoprotein in the Caco-2 cell model after a single short exposure. These results suggest that HePC could modify the oral bioavailability of other therapeutic compounds absorbed via the paracellular route or which are substrates of the intestinal P-glycoprotein.

Une nouvelle technique de stérilisation tubaire sous contrôle hystéroscopique

OBJECTIVES

French study of the feasibility and safety of a new hysteroscopic method for sterilization under local anesthesia.

MATERIALS AND METHODS

After information, all candidates for sterilization were invited to choose between the laparoscopic or hysteroscopic methods. Essure performed under local analgesia was used for hysteroscopic sterilization. Operative time, intensity of pain using a visual analog scale and secondary discomfort were recorded.

RESULTS

A cohort of 57 women were enrolled in this study and 45 chose hysteroscopy. Two were excluded after discovery of an intrauterine pathology during the hysteroscopic procedure. Placement of a bilateral device was successful in 41 patients (90.3%); under local analgesia only in 29 patients (68.3%). Mean time needed for device placement was 25.6 9 min and hospital stay was 9.8 hours. Pain was scored 56/100 on the visual analog scale.

CONCLUSION

Laparoscopy remains the mainstay method used for sterilization but does involve risks. Hysteroscopic device placement seems to be safe, rapid and an effective procedure.

[Sterilization for women using a hysteroscopy technique under local anaesthesia]

OBJECTIVES

and methods The July 2001 law allows capable and consenting adult women to be sterilized after a period of reflection of 4 months and signature of an informed consent formula. The first French study on hysteroscopic tubular sterilization under local anaesthesia using expanding titanium, steel and nickel implants, is reported.

RESULTS

From February to October 2002, 25 women, with a mean age of 40 years, having conceived 2 or more children, benefited from this technique. The duration of the surgical procedure was a mean of 26 minutes (range: 16 to 57 minutes). In 2 women presenting with uterus retroversion, catheterisation of the fallopian tubes was impossible. Local anaesthesia was only used in 15 women, and led to the reduction in the number of days of hospitalisation.

CONCLUSION

This pilot study confirms the feasibility of trans-cervical sterilization of women under local anaesthesia.

Assessment of cytochrome P4502E1 induction in alcoholic patients by chlorzoxazone pharmacokinetics

Chlorzoxazone is mainly metabolized to 6-hydroxychloroxazone (6-OHchlorzoxazone) by the ethanol-inducible cytochrome P450 2E1 (CYP2E1). To evaluate the impact of ethanol consumption on the enzyme induction, the pharmacokinetics of chlorozoxazone and 6-OHchlorzoxazone were studied in alcoholic and control subjects. Fifteen alcoholic male inpatients (all smokers, daily intake 333 +/- 191 g of absolute ethanol) and 20 healthy male volunteers (10 smokers and 10 non-smokers, weekly intake < 100 g of absolute ethanol) participated in this study. Following a 12 hr fasting period, each subject was orally administered 500 mg of chlorzoxazone. Venous blood and urine samples were collected over a 10 hr period. Areas under the curve of plasma concentration versus time (AUC) of chlorzoxazone and 6-OHchlorzoxazone was calculated. The total plasma clearance of chlorzoxazone was measured as the dose/AUC ratio. The mean total plasma clearance was not different between smoker and non-smoker controls but it was enhanced by 73% in alcoholic patients. These results indicate a negligible and non-significant effect of cigarette smoking in controls but an increased metabolism of chlorzoxazone in alcoholic patients (P < 0.05). This increase was corroborated by the 2-fold enhancement of the 6-OHchlorzoxazone/chlorzoxazone AUC ratio, compared to controls. A good correlation was found between this AUC ratio and the 6-OHchlorzoxazone/chlorzoxazone concentration ratio at t = 2 hr in patients and in controls (r = 0.88 and 0.85, respectively, P < 0.01). The concentration ratio increased by 150% in alcoholic patients and decreased by 65% in the seven alcoholics tested after 7 days of alcohol abstinence. It is therefore concluded that the 6-OHchlorzoxazone/chlorzoxazone concentration ratio at t = 2 hr could constitute a simple and non-traumatic marker of CYP2E1 induction.