[Facial feminization, history, evolution of objectives]

The author's experience dates from 1990, during the period when he was in charge of the feminization of the facial skeleton in order to improve the social integration of male transsexual patients. Very quickly, these techniques were extended to genetic women who wanted a more feminine face. This facial skeletal surgery was then supplemented with soft tissue surgery. This skeletal and volumetric surgery has become an important contribution in the search of facial rejuvenation and beauty.

[Benefits of volumetric to facial rejuvenation. Part 2: Dermal fillers]

Injectable substances known as fillers are used to palliate age-related atrophy and ptosis, and for their so-called "pseudo-lifting" action. They do not replace face and neck lift, but allow it to be postponed or, when injected after surgical lifting, make the result durable. Hyaluronic acid has a predominant and unchallenged place among fillers, well ahead of poly-L-lactic acid or calcium hydroxyapatite. Approaches and injection methods are the same for all fillers, corresponding to those for autologous fat injection, the reference substance, with a few particularities. The substance used, the level of hyaluronic acid reticulation, and the depth of the injection depend on the injection site and intended effect. Effects range from smoothing superficial wrinkles to remodeling whole parts of the face. Complications related to such fillers are well known, especially in the case of hyaluronic acid, where overcorrection is the most frequent. To limit the risk of complications and also to offer each patient the most individually adapted corrections, before any procedure, the plastic surgeon needs to question the patient and perform precise medical examination.

[Lipofilling]

Autologous fat can be considered to be a gold standard implant by virtue of its volumetric qualities and its action on skin trophicity. Improved techniques have transformed fat injections into reproductible adipocyte grafts with permanent results.

Les produits injectables lentement et non résorbables

Products which are non absorbable or slowly absorbable make the correction of facial wasting of any origin possible. These highly efficient products are unfortunately sometimes responsible for complications or even undesirable after effects. In order to avoid this the following are necessary: clinical and histological analysis of facias granulomas, a proposal for guidelines for their use which would predict in situ tolerance.

[Contrast-enhanced MRA of the carotid arteries using 0.5 Tesla: comparison with selective digital angiography]

PURPOSE

To assess the feasability, the imaging quality and the effectiveness of contrast-enhanced MRA (CE MRA) using a 0.5 Tesla MR unit in the evaluation of internal carotid artery (ICA) stenosis. Materials and Methods. 29 patients underwent CE MRA and selective digital substraction angiography (DSA). All data were reviewed in a blinded fashion by 2 independant observers. Imaging quality was graded as good, moderate but interpretable, and insufficient. Stenosis was graded according to the NASCET classification from grade 1 to 4, with the following thresholds:<30%,<70%,<99% and occlusion. Inter and intra- observer agreement was evaluated using the kappa index.

RESULTS

Imaging quality was good for 79 arteries, moderate for 24 and insufficient for 13 (k MRA=0.72 and 0.64 respectively for the right and left ICAs). Interobserver agreement was good with values for right/left ICA of 0.84/0.94, 0.72/0.74 respectively for CE-MRA and DSA. For the comparison between CE MRA and DSA, agreement was also good, with values of 0.74 and 0.64 for both readers. Sensitivity of CE MRA in the detection of hemodynamically significant stenosis (>70%) was of 0.95 and 0.94 and specifity of 0.91 and 0.89 respectively for reader n degrees 1 and reader n degrees 2.

CONCLUSION

CE MRA using a 0.5T MR unit is a valuable technique in the evaluation of ICA stenosis.

A treadmill ergometer for three-dimensional ground reaction forces measurement during walking

This report describes new treadmill ergometer designed to measure the vertical and horizontal ground reaction forces produced by the left and right legs during walking. It was validated by static and dynamic tests. Non-linearity was from 0.2% (left vertical force) to 1.4% (right antero-posterior force). The resonance frequency was from 219 (right vertical direction) to 58 Hz (left medio-lateral direction). A calibration "leg", an air jack in series with a strain gauge, was developed and used to produce force signals comparable to those obtained during human locomotion. The mean differences between the force measured by the calibration leg and treadmill ergometer at 5 km h(-1) were 3.7 N (0.7%) for the left side and 6.5 N (1.2%) for the right. Measurements obtained during human walking showed that the treadmill ergometer has considerable potential for analysing human gait.

[Gait analysis of 57 healthy children by measurement of ground reaction forces on an Adal treadmill]

PURPOSE OF THE STUDY

The purpose of this study was to present a new treadmill proposed for evaluating gait in children. We analysed differences in ground reaction forces between boys and girls, and we calculated the symmetry index in healthy children.

MATERIAL AND METHOD

Time and ground reaction forces of about 30 steps were measured using a new treadmill. The apparatus consists of 2 walking belts which function as two independent treadmills placed side by side, separated by 4 mm. The 2 treadmills were mechanically separated in order to allow independent measurement of the ground reaction forces induced by each lower limb during stance phase. The children (28 boys and 29 girls), all clinically healthy, were divided into three groups according to their height (between 105 and 150 cm). They walked at three different velocities (2.7 km/h, 3.6 km/h and 4.5 km/h according to their height). The graphs representing the subject's measurements were composed of fore-aft, medial-lateral, and vertical parameters. The analysis of these graphs considered stride, stance, double stance and nine specific points. We also calculated the symmetry index of each child.

RESULTS

We determined the values of the symmetry index in healthy children. We did not find any significant difference in gait between girls and boys, except for Fz3 at 2.7 kg/h, where Fz3 was higher in girls than in boys.

DISCUSSION

We compared our results with those reported in the literature and found that ADAL has a very important advantage in gait analysis in children because it is simple and easily accepted by children.

[Radiologic aspects of infarction of the appendix epiploica]

Clinical, US, CT and MR findings were reviewed in 5 patients with primary epiploic appendagitis (3 men, 2 women, mean age 38 years, age range 29-62 years) seen between December 1994 and December 1997. Diagnosis was reached in all cases with CT, with US in 3 and with MR in 1. Follow-up CT was performed in 2 cases and clinical follow-up in 4. One patient underwent surgery. Initial US, CT or MR examinations revealed a fatty oval-shaped nodule located anteriorly or anterolaterally to the left colon. The greater diameter ranged from 20 to 30 mm. Perinodular lesions with strands of periappendicular fat and thickened parietal peritoneum were visualized in all cases without any other inflammatory process in the abdomen. Symptoms resolved within 4 days in all patients. Signs of fatty inflammatory processes resolved in the 2 patients who had follow-up CTs. Primary epiploic appendagitis has characteristic US, CT and MR features which help guide medical treatment.

[Imaging of severe forms of hematoma in the rectus abdominis under anticoagulants]

AIM

To describe the US, CT and MRI pattern of the severe rectus sheath hematoma (RSH) complicating anticoagulant therapy.

MATERIALS AND METHODS

CT scans were performed in thirteen patients (12 women, 1 man) aged from 53 to 90 (mean age, 74) with severe RSH. Five patients also underwent ultrasound examination and three MR examination. Nine patients (69%) were receiving subcutaneous injection of heparin, three (23%) oral anticoagulant therapy and one continuous IV infusion of heparin. Clinical diagnosis was reached in 6 cases. Excessive activity of anticoagulant therapy was noted in 4 cases. The location of the RSH, their densities and their signal were analysed.

RESULTS

All the RSH were mostly developed in the lower third of the abdominal wall, had a large spreading into the Retzius space and compressed the bladder and/or the bowels. RSH were all hyperdense and in 8 cases (61%) a fluid-fluid level due to the hematocrit effect was noted. In one case, a retroperitoneal hematoma was discovered. The extension of the RSH was well delineated with MRI. The RSH showed itself with heterogeneous signal intensities with areas of high-signal-intensity on T1-weighted images. Fluid-fluid levels and a concentric ring sign were also noted.

CONCLUSION

Older women with subcutaneous injection of heparin are especially prone to RSH even though there is no overall excessive activity of anticoagulant therapy. Clinical and biological diagnosis may be difficult. CT scan is the exam of choice to reach a precise and acute diagnosis of RSH.

[Pseudospondylodiscitis in chronic hemodialysis. Apropos of 2 cases and review of the literature]

The spondyloarthropathy of patients on chronic dialysis is a new entity of still obscure pathogenesis. Two cases are reviewed and the documented data analyzed. Radiologic images suggestive of an infectious spondylodiscitis impose performance of a puncture biopsy for bacteriology and histology.