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Background: Data on lymphoedema in Africa is scare. Our aim is to determine the epidemiological features and etiological factors of lymphoedema in Dakar. Methodology: A 20 years retrospective study of all patients presented lymphoedema in dermatology department of Aristide Le Dantec hospital in Dakar. Results: 309 cases which representing 0.2% of total consultations were studied. The sex ratio was 0.97 and the average age was 42.4 years. The duration of evolution before the consultation ranged from 11 days to more than 20 years. Lymphedema of the lower limbs was found in 90% and the upper limb in 3.5%. Among patients with lower limb lymphedema, 68.7% had had a unilateral form while upper limbs involvement was bilateral in 18.2%. 6.4% of patient showed multiple localizations. Lymphedema was primary in 14.5%. Among primary lymphedema a case Meige disease and a case of Noone-Milroy syndrome were noted. Secondary causes included bacterial cellulitis in 41.7%, sarcoma of the disease in 31.7%, venous insufficiency in 7.12%, 2.26% in trauma. 100% cases of bacterial dermohypodermitis, 78% cases of Kaposi's disease, 100% cases of venous diseases, 85% of traumatic causes and 75% of iatrogenic lymphedema happened in lower limbs. All multifocal forms were associated with Kaposi's sarcoma. Conclusion: the causes of lymphoedema in tropical regions are dominated by secondary forms mainly bacterial dermohypodermitis and Kaposi disease. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a rapidly progressive soft tissue infection characterized by extensive necrosis in the deep and superficial fascia. This is a polymicrobial infection in about 70% of cases. Monomicrobian infection is usually caused by β-hemolytic group A streptococcus. Monomicrobian necrotizing fasciitis due to multidrug-resistant Acinetobacter baumannii is rare and usually occurs in immunocompromised patients with a medical history. In these subjects, the infection is severe and fatal due to the decompensation of the underlying defects and septic shock. The occurrence of this clinical disease in healthy subjects is rare. We report the case of a 54-year-old healthy man with monomicrobian necrotizing fasciitis of the left leg due to multidrug-resistant Acinetobacter baumannii; patient's outcome was favorable after extensive surgical debridement. [ABSTRACT FROM AUTHOR]

Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature.

Introduction: skin cancers are malignant keratinizing tumors of epidermal, melaninic or adnexal origin. These cancers are still little known. However they affect people living in Madagascar where the amount of sunshine remains very high with an impact that varies depending on the skin type. The purpose of our study was to determine the epidemio-clinical profile of skin cancers in Antananarivo. Methods: we conducted a retrospective descriptive study of skin cancers in the Department of Oncology of the Joseph Ravoahangy Andrianavalona Hospital, Antananarivo over a period of seven years. It included patients with tumoral skin lesions confirmed by histological examination. Results: we collected data from 47 cases of skin cancers (male predominance; sex ratio 1.13). The average age of patients was 49.3 years. Farmers were the most affected. The lesions mainly occurred in the head, neck (44%) and lower limbs (42%). Localized skin cancers were detected in 61.7% of cases. Squamous cell carcinoma was the most common skin cancer in Madagascar (37%), followed by the melanoma (21%) and the basal cell carcinoma (11%). Treatment was mainly based on surgery (74.19%). Conclusion: squamous cell carcinoma is the most common cancer in Madagascar, followed by melanoma and basal cell carcinoma. Skin cancers affect mainly the young population and require appropriate management. [ABSTRACT FROM AUTHOR]

Coverage of loss of skin substances on the lower third of the leg is a challenging problem. This is due to adjacent soft tissues impairment, shortage of local vascularization and bone exposure. We conducted a retrospective study of a series of 9 cases of skin coverage of the lower third of the leg treated at the University Hospital Hassan II of Fez from 2016 to 2018. This study aims to highlight the characteristic of the loss of skin substances on the lower third of the leg, while emphasizing the difficulty of management. [ABSTRACT FROM AUTHOR]

Neonatal gangrene is a rare condition during the neonatal period. Its prognosis is generally poor. Acute ischemia of the limbs is most often caused by thromboembolic events. Although there are several predisposing factors, in the majority of cases no causative factor is found. Also the extent of the gangrene is variable; it can affect one or several fingers or toes or even the whole upper or lower limb. We here report a case of congenital gangrene of the hand treated in our Department. [ABSTRACT FROM AUTHOR]

The use of new technologies and social networks is often characterized by the fatuity of observed practices. These activities are often centred on the «phatique» function of communication (making contact, superficial exchanges, humorous information etc.) However, there are sites that allow to acquire much knowledge or know-how in a variety of areas and to be trained in the practice of certain activities of leisure or professional. Thanks to the presentation possibilities offered by the digital (animations, videos with overlay of multiple plans, etc.) learning may even appear more efficient than in a traditional face-to-face courses. In this article, we study the efficiency of this type of training with the goal of learning a musical instrument: drums. Drums are musical instrument that require a greater independence of the body because the upper and lower limbs each have a function that is not necessarily coordinated with the other members. As a result, in a traditional course, teacher who demonstrated in front of a student usually saturates perceptive channels of the latter who must share his attention on what is happening with two arms and two legs in a very short time and this besides striking techniques (open or closed hi-hat, ghost (weak) notes etc.) We make the assumption that a video presentation of the same demonstration with separate views on the top and bottom of the body could allow a better understanding of gestures techniques that occur during the practice of this instrument as the learner can control the pace of scrolling, go back, replay part of the looped video and focus its attention on the part of the body that interests him. The possibility of reviewing certain sequences seems to us essential to an understanding of this type of gestures and technique. We chose to study a website that offers to learn drums without faceto- face courses, and without formal musical training (Batterieenligne.fr). This site combines many modalities of presentation of information in the same video (metronome, scroll to the partition with mental technique of the rhythm count, view video on the arm and view of the feet, sequences idling etc.) This study will be done in both directions. An inventory of what allows and does not allow a website of this type compared to a traditional course face-to-face. We present a survey of 739 website users to seek their views on the strengths and limitations of these learning situations. The main hypothesis of this study is that the video is probably a great way of learning when demonstrations require a share of attention (the top of the body or feet, technical of strikes). By allowing multiple views, flashbacks, breaks and times, it allows learners perceive phenomena that it does not have time to grasp during a single demonstration of a face-to-face course. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations (AVM) are congenital high-flow vascular defects. They are very rare in children. Diagnosis and treatment are often delayed due to their atypical place of occurrence and to their variable clinical manifestations. We report the case of a child treated at the National Centre Hospitalier Albert Royer Children, Dakar. A boy aged 9 years was referred from a health facility in rural areas for the treatment of heart failure. Admission clinical examination showed impaired general condition, global heart failure syndrome and voluminous right warm inguinocrural mass extended to the right abdominal wall (iliac fossa and right flank), with poorly defined limits. Auscultation of this mass showed a thrill and diffuse murmur. Cardiac ultrasound showed severe pulmonary arterial hypertension (PAH) with extensive impairement of the heart cavities, without cardiac structural involvement. The diagnosis of AVM was confirmed by doppler ultrasound of the mass complemented by angiography scan. They showed multiple arteriovenous fistulas within the mass. The diagnosis of complex stage IV AVM (according to Schöbinger classification) of the root of the right thigh was retained. Clinical treatment of heart failure was based on furosemide, spironolactone and captopril to obtain hemodynamic stabilization before possible surgical procedure. Arteriovenous malformations of the limbs, in particular of the proximal end of the lower limb in children are still largely unknown, hence frequent diagnostic errors and delays. Their evolution is unpredictable requiring early diagnosis and careful monitoring involving multidisciplinary interaction between pediatrics, surgeons and radiologists. [ABSTRACT FROM AUTHOR]

Macrophage activation syndrome (MAS) is a multisystemic disorder resulting from an over-activation of the immune system leading to a more or less diffuse macrophagic infiltration into the tussues. Clinical signs including fever, hepatosplenomegaly, adenopathy are associated with abnormal values in laboratory test results (bi or pancytopenia, hepatic cytolysis, elevated LDH levels, coagulopathy) and hemophagocytosis. In children, it can be primary or secondary to several disorders. We report the case of a 16-year old patient admitted to the Department of Pediatrics with febrile leukopenia associated with impaired general condition and circular erythematous lesions spread to the lower limbs. The diagnosis of macrophage activation syndrome was retained based on clinical signs, laboratory test results and cytological results. Skin biopsy of these lesions showed subcutaneous panniculitis-like T-cell lymphoma. The purpose of this study is to insists on the peculiarities of this clinical case given the rarity of this type of subcutaneous T-cell lymphoma, much more in this age group. We want to highlight the importance of suspecting subcutaneous T-cell lymphoma in patients with MAS associated with subcutaneous erythematous lesions because this could be life threatening. [ABSTRACT FROM AUTHOR]

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Archéologique de Picardie is the property of Revue Archeologique de Picardie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents the case study of a 30-year-old man with dyspnea decubitus. Topics include reporting a history of exacerbating dyspnea progressive and fatigue developing for 6 months; and associated with an increase in the volume of the two lower limbs taking the bucket without notion of family cardiovascular pathology and without particular antecedents.

The fractures of the distal quarter of the leg are characterized by fracture line located at the level of the lower quarter of the tibia, according to Gerard and Evrard definition [1]. They are serious and pose problems for consolidation, immobilization and stability. We here describe our experience in the Department of Orthopaedics and Traumatology at the Avicenne Military Hospital, Marrakech. We report 30 cases of closed fractures of the lower quarter of the leg treated with centro-medullary nailing over a period of 10 years (January 2001-December 2010). Locked nailing was performed in 80% of cases and simple nailing was performed in the other cases. The average age of patients was 36 years. There was a clear male predominance (27 men, 3 women). The average time for consolidation was 17 weeks and functional outcomes were satisfactory. A single case of infection occurred 6 months after surgery (3.3%) and no other complication was reported. Malunion was detected in 30% of patients. Our epidemiological data and results were almost identical to those in the literature. Angular results were significantly lower than those obtained with the series of plates. By contrast, data on infections called for caution and some nails produced excellent angular results when nail fixation was stable. In the light of these results, codified indications for locked centro-medullary nailing should be extended to the fractures of the lower quarter of the leg, provided that stable fixation using double screw distal locking and primary osteosynthesis of distal fibula fractures are performed. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Les pertes de substance distales des membres inférieurs sont encore un défi pour le chirurgien plasticien. Il faut apporter une couverture efficace et fonctionnelle avec un minimum de séquelle pour le site donneur. Le lambeau libre antérolatéral de cuisse présente dans ces domaines de nombreux avantages par rapport aux lambeaux locaux pédiculés et aux lambeaux musculaires libres classiquement utilisés. Nous essayons de définir sa place à travers notre expérience par une étude rétrospective bicentrique. Patients et méthodes Une analyse rétrospective exhaustive des cas de reconstruction des pertes de substance distales des membres inférieurs par lambeau libre antérolatéral de cuisse a été effectuée dans 2 centres de chirurgie réparatrice. Les caractéristiques des pertes de substance et des reconstructions ont été collectées. Le taux de succès et le taux de complications ont été rapportés, ainsi que les résultats esthétiques et fonctionnels à distance. Résultats Quarante et un patients ont été reconstruits entre 2008 et 2013 pour une prise en charge post-traumatique dans 58,5 % des cas. La taille moyenne des pertes de substance était de 191,4 cm 2 , leur localisation était principalement sur le pied et la cheville (61 %) et une exposition osseuse était le plus souvent retrouvée (82,9 %). Le taux de succès était de 92,8 %. Les résultats fonctionnels étaient jugés comme très bons et bons dans 75,5 % des cas et les résultats esthétiques comme très bons et bons pour 63,6 % des cas. Trois patients « perdus de vue » soit 7,3 % et 3 échecs soit 7,3 % n’ont pas pu être évalués sur le résultat final. Conclusion Montrant des résultats fonctionnels au moins similaires aux autres lambeaux, l’antérolatéral de cuisse fait la preuve de sa fiabilité et limite les séquelles au site donneur à une simple cicatrice ou greffe de peau mince. Sa polyvalence permet de s’adapter à la grande majorité des cas de reconstruction des pertes de substance des membres inférieurs. Summary Context Soft tissue defects of lower leg are still a challenge for the plastic surgeon. It should provide an effective and functional coverage with a minimal morbidity on the donor site. Free anterolateral thigh flap present in these areas many advantages over the pedicled local flaps and free muscle flaps used conventionally. We try to define its place through our experience with a bicentric retrospective study. Materials and methods A retrospective analysis of all cases of reconstruction of the lower leg using the free ALT flap was performed in two centers of reconstructive surgery. The characteristics of the defect and reconstructions were collected. The rate of success and complication has been reported as well as long term aesthetic and functional outcomes. Results Forty-one patients were reconstructed between 2008 and 2013 for post-traumatic care in 58.5% of cases. The average size of the defect was 191.4 cm 2 , their location was mainly on the foot and ankle (61%) and bone exposure was most frequently found (82.9%). Success rate was 92.8%. Functional results were judged as very good and good in 75.5% of cases and aesthetic results as very good and good for 63.6% of cases. Three “lost sight” 7.3% and 3 fails (7.3%) patients were not included in the result analysis. Conclusion Showing functional results at least similar to other flaps, ALT flap demonstrated its reliability and its low morbidity on the donor site. Its versatility allows adaptation to the vast majority of defects of the lower leg. [ABSTRACT FROM AUTHOR]

Résumé Le mycétome est une maladie infectieuse, bactérienne ou fongique, qui affecte la peau et/ou les tissus mous et qui peut se compliquer d’atteinte osseuse. L’aspect clinique le plus fréquent est celui d’une tuméfaction fistulisée du pied, mais des localisations extrapodales sont possibles. Nous rapportons un cas de mycétome extrapodal chez un homme de 47 ans, reçu pour une tuméfaction polyfistulisée de la jambe évoluant depuis deux ans, chez qui l’examen anatomopathologique a permis de confirmer le diagnostic de mycétome actinomycosique et la TDM de montrer l’importance de l’extension osseuse et aux parties molles. Ce cas était caractérisé par le caractère très inflammatoire de la tumeur, sa localisation à la jambe sans atteinte podale, la modicité des signes fonctionnels par rapport à l’importance des atteintes osseuses radiologiques, la pandiaphysite très destructive de la fibula tandis que le tibia était quasi intact et la bonne réponse au traitement. Malgré l’aspect clinique souvent évocateur, le diagnostic de mycétome est encore souvent tardif dans notre pays, au stade d’extension osseuse et/ou articulaire. Des mesures pour réduire les retards au diagnostic des mycétomes doivent être une priorité. Summary Mycetoma is a bacteriological or fungal infectious disease affecting the skin and/or soft tissues, which can be complicated by bone involvement. The most common feature is a tumor of the foot, but extrapodal localizations have been described. We report one case of a 47-year-old man who presented with tumefaction of a leg with multiple skin fistulae. Histopathological examination permitted to confirm the diagnosis of actinomycetoma and TDM showed the degree of bone and soft tissues involvement. Our case was characterized by the very inflammatory aspect of the tumor, its localization to the leg without foot involvement, the modest functional signs compared to the importance of radiological bone involvements, the deep destruction of the fibula while the tibia was apparently intact and the good response to treatment. In spite of its characteristic features, diagnosis of mycetoma is still late in our country, often with bone and/or articular spread. Priority may be given to measures for reduction of mycetoma diagnosis lateness. [ABSTRACT FROM AUTHOR]

Copyright of Foot Medicine & Surgery / Medecine et Chirurgie du Pied is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Suggest a surgical thinking for a multidisciplinary problem is inevitably difficult. Nevertheless, through targeted clinical examples, we tried to prioritize our clinical and intellectual approach for advanced tumors of the cephalic extremity. In these cases, decisions can only be collegial, and respect for the patient and his choices remain essential. Ultimately, we would argue this problematic, discussing successively the histological type, ethical concern with regard to clinic, operability and reconstruction opportunities. [Copyright &y& Elsevier]

Summary: Background: Surgery is the standard treatment of the chronic compartment syndrome in the lower limb (CCSLL). However, pain and activity restrictions may persist after surgery. Objective: To assess the clinical outcomes after surgery in CCSLL and to find some prognosis factors. Method: Retrospective study on 16 patients surgically treated, mean age 27 years three quarter. Symptoms before surgery lasted from three months to two years (median ten months). The treatment evaluation was achieved by a questionnaire during a phone call. Results: Among the patients, 37,5% reported no pain at all and 62,5% retrieved an activity level equal to their previous practice. Decreased activity level occurred when the posterior compartment was involved (P =0.008) and when the initial symptoms were atypical (P =0.035). An atypical clinical presentation may also lead to incomplete pain sedation (P =0.011). Conclusion: The results of the surgical treatment are variable, on pain as on activity level and depend on the compartment involved and the initial clinical picture. In these circumstances, the search of an alternative diagnosis is essential. [Copyright &y& Elsevier]

Summary: Objective: Fatigue of lower limb presents various impacts on postural control. The purpose of this study was to explore the effects of a unilateral lower-limb muscle fatigue on undisturbed stance. Methods: Nine healthy men performed until exhaustion a fatiguing exercise of the limb extensor muscles of one leg (exercised leg). Just before and after the fatiguing exercise, postural sway measures (centre of pressure) were recorded simultaneously from a double force platform and an in-shoe pressure system in quiet standing conditions. Maximal plantar pressure was computed from each sensor of the in-shoe system, before being averaged for the medial and lateral heel, the external mid-foot, the external and internal foreparts. Results: In undisturbed stance, the fatiguing exercise induced postural destabilisation for the non-exercised leg (P <0.001). Changes in antero-posterior mean position of the exercised leg were also observed reflecting a mean loading in a more rear foot stance (P <0.01). The in-shoe system parameters revealed for the exercised foot, an increase of the maximal pressure value for the heel region (P <0.05) and a decrease for the mid-foot and forepart (P <0.05). For the non-exercised foot, the maximal pressure decreased only in forepart (P <0.05). Conclusions: Unilateral triceps surae fatigue revealed an immediate destabilisation of undisturbed stance and the observed postural strategy appears similar to these developed by patients who presented pain pathology and/or sensory deficits in lower limb. [ABSTRACT FROM AUTHOR]

Summary: An echogenic tumor (22×22mm) isolated from the anterior part of the left leg at 27 WA of pregnancy suggested an angiomatous structure. This mass appeared to be well vascularized on Doppler examination. Three-dimensional imaging showed connections with adjacent tissues. The limbs were mobile. Delivery of a 3990-g-boy occurred normally. On the anterior part of the left leg, there was a plate-shaped mass with a pink hole at the superior part. Excision under general anesthesia was performed at the first month because of the risk of rupture and bleeding. The dissection was easy with the deep plane. Healing was complete 10 days after the surgical procedure and the aesthetic aspect was good 1 year later. Histological findings of the suspect mass emphasize the vascular aspect of the tumor. A hemangioma capillary with venous structures in the dermal hypodermic area was found. [Copyright &y& Elsevier]

Summary: Pilomatrixoma is a benign skin neoplasm of the hair follicle. It''s common in the pediatric population. It''s usually misdiagnosed and confused with other skin lesions. Head and neck represent the usual locations. The extremity remains an exceptional location. Through an observation of a pilomatrixoma of the leg in an adult patient treated surgically without recurrence, different diagnostic and therapeutic aspects of this pathology will be recalled. [Copyright &y& Elsevier]

This paper presents a synthesis of different studies willing to bring a scientific insight into leg compression, which is the process of applying external compression forces onto the human leg with stockings or socks, for enhancing the venous flow. It seems obvious that the pressure distribution on the leg affects the blood flow in the veins. However, the pressure distribution that leads to the optimal blood flow is not trivial, and it is different with regard to the application: medical treatment or recovering after an effort in sports. In order to improve the scientific knowledge about this topic, a numerical 2D model was set up for computing stress fields inside the leg, accounting for the actual material properties of both the compression stocking and of the leg biological tissues. Suitable identification methods, based either on model updating from digital image correlation (for the compression stockings), or on image warping and model updating from MRI scans (for the internal leg tissues), were developed for retrieving these material properties. [ABSTRACT FROM AUTHOR]

Objective: To assess if electrostimulation of lower limbs relieves lower limbs venous insufficiency-related symptoms during pregnancy. Patients and methods: A two-step study was conducted. First, a monocentric prospective preliminary study including 30 pregnant women was conducted to assess the effects of electrostimulation on fetal monitoring and uterine contractions. Then, a multicentric prospective non-randomised study including 58 pregnant women with a gestational age between 23 and 33 weeks of amenorrhoea was conducted to evaluate the electrostimulation treatment. This evaluation was based on a clinical examination performed pre- and post-treatment, a CIVIQ questionnaire filled out pre- and post-treatment and a daily diary filled out by the patient during treatment duration. Treatment duration was 21 days including two daily treatment sequences of 20min. Three groups of patients were identified based on initial intensity of venous insufficiency-related symptoms (group 1 minor symptoms, group 2 moderate symptoms, group 3 severe symptoms). Results: Preliminary study showed no interferences between electrostimulation and fetal cardiac rhythm, uterine contractions and maternal uterine and fetal umbilical arteries Doppler. Concerning the evaluation of the electrostimulation: in group 1, electrostimulation significantly reduced heavy legs sensation (p <0,001) and calves pain (p =0,02) between the beginning and the end of the treatment. The four scores calculated with the CIVIQ questionnaire decreased after treatment and a significant reduction was noted for generalised pain feeling (p =0,04) and psychological impact (p =0,03). In group 2, a significant decrease was noted for tiredness (p <0,001), heavy legs sensation (p <0,001), calves pain (p <0,001) and edema (p =0,02) between the beginning and the end of the treatment. The four scores calculated with the CIVIQ questionnaire significantly decrease after 21 days of treatment. In group 3, a significant decrease of heavy legs sensation (p =0,03) and calves and malleoli perimeters (p <0,05) was noted. After 21 days of treatment, the four scores calculated with the CIVIQ questionnaire significantly decrease (p <0,05). When comparing the three groups, beneficial effects of the treatment are most marked in group 2 regarding subjective symptoms, CIVIQ questionnaire scores and leg pain. According to the patients, effectiveness and tolerance of the treatment ranged from good to excellent in the three groups. Discussion and conclusion: Electrostimulation is an effective and well-tolerated treatment of lower limbs venous insufficiency-related symptoms in pregnant women. Its use during pregnancy did not show any effects on fetus and pregnancy. [Copyright &y& Elsevier]

Abstract: The authors report the clinical history of a patient having presented a cutaneous mucormycosis at the waning of a traumatic dilapidation post of the left lower limb. Mucormycosis is an opportunist fungic infection due to mushrooms of the group of the mucorales present in the environment. There are various clinical forms of the disease; it occurs in general on a defective predisposed ground. The diagnosis rests on the mycologic and anatomopathologic examination. The therapeutic approach must be multidisciplinary; on the precocity of the treatment depends the vital and functional forecast. [Copyright &y& Elsevier]

Abstract: Purpose: Our aim is to describe the skeletal manifestations of Behcet''s disease (BD) among young adults in a military population. Methods: We conducted a retrospective study of 176 patients with BD who were followed between 1980 and 2005. All the patients fulfilled the international study group on Behcet''s disease diagnostic criteria. Results: Rheumatic manifestations were noticed in 79 out of 176 patients (45%), ranking second after the skin and mucosal manifestations of the disease. Articular manifestations were the first disease manifestation in 16.5% of the patients. Inflammatory arthralgias were the most common manifestation and observed in 81%, interesting mainly the large lower limb joints. Disease course was acute in most of the patients. Arthritis was less common: oligoarthritis (7.5%), monoarthritis (6.5%) and polyarthritis (5%). Axial involvement was also noted: spine pain in 29%, isolated sacroiliitis in 7.5%, and definite ankylosing spondylitis in 5%. Conclusion: Joint involvement is common in BD and could be the first manifestation of the disease. Most of the patients present with inflammatory arthralgias of the large lower limb joints. Disease course is usually favourable, spontaneously or with treatment. However, in our study population, skeletal manifestations were responsible for significant disability. [Copyright &y& Elsevier]

Abstract: Distal extremity of lower limb sustains the complications of loss of tissue: problem of coverage (cutaneous and tendon necrosis, osteoarticular infection. The whole point of the surgery is to fight against the infection by repeated debridments, against the deformations or their correction by early osteosynthesis (pins and external fixation). The coverage is very important in this treatment: either with Vacuum-Assisted Closure (VAC®) and skin graft or fasciocutaneous flap. In spite of this management, the after-effects are important although the conservative treatment is the determining factor of satisfaction. [Copyright &y& Elsevier]

Abstract: The author reports his experience and the interest in using small pedicled muscle flaps in the coverage of small cutaneous size defects around the ankle and the distal leg. In such defects, the bad cutaneous status often precludes the use of fasciocutaneous flaps, and the use of wider muscle pedicled flaps or even free flaps is excessive. Because of their small sizes, the muscles used in our series, often considered as accessories, appear very useful. [Copyright &y& Elsevier]

Abstract: Major causes of ballistic wounds are shooting accidents. Goals of this work are to suggest a position about ballistic wounds of leg''s distal third. Reconstruction of ballistic wounds of leg''s distal third is difficult, because of lack of laxity and veinous drainage in distal third; and characteristics of ballistic wounds. Ballistic traumas give a temporary cavity, which induce levelled wounds of neurovascular pedicules. We present three cases. One patient benefits from a sural flap, whereas the two others benefit respectively from a free parascapular flap and a free latissimus dorsi flap with free osseous graft. Functional results were considered as good. Treatment of ballistic wounds ask for certain specificities: 1) meticulous evaluation of wounds; 2) evaluation of vascular axis of leg. Debridments are numerous under general anaesthesia before a reconstruction with axial regional flap or free flap, which vessels are anastomosed distant. Reconstruction must be done before the tenth day. [Copyright &y& Elsevier]

Abstract: Purpose: The distally based fasciocutaneous flaps of the leg are very useful for the treatment of skin defects at the lower third of the leg and the foot, but the venous congestion due to the reverse flow can be responsible of necrosis at the distal part of the flap. The anastomosis of the lesser saphenous vein which is included in the flap''s dissection to the greater saphenous vein near the defect avoid this venous congestion and the necrosis of the most useful part of the flap for the coverage of these defects. Material and methods: From January 1999 to June 2005, 15 patients aged between 22 and 64 years old have benefited for the treatment of soft tissue defects secondary to trauma with a mean diameter of 7×10 cm and located in 7 cases at the lower third of the leg and in 8 cases at the posterior side of the heel, from distally based posterior fasciocutaneous flaps where the venous reverse flow has been changed in a physiological one by the terminolateral anastomosis between the lesser and greater saphenous vein. The dissection of these flaps was classical except that the lesser saphenous vein was dissected 6 cm beyond the proximal part of the flap in the popliteal region. Results: In all these flaps, there was no venous congestion and no arterial problems. With a mean follow-up of 40 months, the coverage''s quality of these defects was very satisfactory. No sequellae are reported. Conclusion: The anastomosis between the lesser and the greater saphenous veins seems to eliminate the main source of failure of the distally based fasciocutaneous flap of the leg and can reinforce the indications of these flaps for the treatment of such defects. [Copyright &y& Elsevier]

Abstract: Calciphylaxis presents like subcutaneous lesions with livedo reticularis leading to necrotic and painful ulcers, predominantly in the lower limbs and the abdomen. They initially simulate dermohypodermitis. Biology reveals secondary hyperparathyroidism, phosphocalcic metabolism abnormalities and state of hypercoagulability. Histological signs are constant: calcifications in the media of small and sub-cutaneous arteries, intimal hyperplasia and intravascular thrombosis. This complication occurs in 4% of end-stage renal disease patients. Its prognostic is awful with a rate of mortality of 60% due to sepsis. Treatment is based upon the normalization of phosphocalcic rates and local debridement. [Copyright &y& Elsevier]

Abstract: Purpose. – The aim of this study was to examine Optojump system efficiency to analyse lower limbs explosive strength. Methods and results. – Twenty untrained subjects were randomly assigned to 2 groups: either an experimental group (N =10) or a control group (N =10). They performed vertical jumps using different techniques and sprints. Reproducibility of jumps and sprint, evaluated by Optojump system, was appreciated after correlation analysis . The experimental group took part in a plyometric training for six weeks. Jumps and sprints showed an excellent reproducibility (mean coefficiant of variation=3.6%). Plyometric training increased (P &#60;0.001) counter movement jump (+19.6%), counter movement jump free arms (+14%) and drop jump (+27.9%) performances. Conclusion. – This study demonstrated the accuracy and validity of the Optojump system to analyse lower limbs explosive strength. [Copyright &y& Elsevier]

Abstract: Goal. – We tested in this study the possibility of influencing leg stiffness through instructions on the knee flexion in drop jump (30 and 60 cm). Method. – Twelve basket players were instructed to jump with three different instructions: 1) “jump as high as you can”; 2) jump high with a larger knee flexion at touch-down and 3) jump high with a smaller knee flexion at touch-down. The ground reaction force were measured with an AMTI force plate (500 Hz). The kinematics of the jump was recorded using two digital cameras (50 Hz). Results. – The results show that the ground reaction force pattern depended more on the instruction than on the height of the box. The active peak decreased from 6 times the body weight (BW) to 2.9 times BW. Bending the knee appears to be an efficient strategy to increase the leg stiffness [R =0.86; P &#60;0.05]. Conclusion. – The instructions high knee flexion decreases the leg stiffness. The same vertical jump performance could be achieved with different values of stiffness. The maximum knee flexion does not modify the vertical performance. [Copyright &y& Elsevier]

Copyright of EMC-Rhumatologie--Orthopedie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Radiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Anesthesie--Reanimation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Cardiologie-Angeiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. – The objective of our study is to evaluate the functional and professional becoming of lower limb amputated population with prosthesis.Material and methods. – Our study is retro-prospective. It interested lower limbs amputated patients who have beneficed during the period between 1982–1998 with prosthesis and have consulted in 1999. Data of our study were gathered by an hetero questionnaire. In order to evaluate the functional results of our patients, we have adopted the score established by the National association of doctors specialized in apparatus in France (ANMA). However, this score was little modified (in fact, we have eliminated the item “use of personalized vehicle for handicapped [VHP]”, because no one of our patients possess it). The results were judged favourable: score 6–7; unfavourable: mean score between 3–5 and bad between 0–2.Results. – During the year of our survey, we have questioned 85 lower limb amputated patients with prosthesis: 67 were male and 18 were female. The mean age of our patients is 48 years (6 to 86 years). Our population was divided into: 31 traumatic amputated, 28 arteritics and 26 amputated of other etiologies (tumoral, infectious, congenital….). In 76 cases, the amputation is unilateral. It’s located upper the knee in 51 cases. The evaluation of functional autonomy of our patients according to score adopted showed those results: 54.11% were favourable and 45.88% were unfavourable. In professional side, only 35 among our 60 actives patients before amputation, have been able to resume, 12 have needed a professional rehabilitation. Among the 25 who hadn’t taken up again their work, 15 have early retirement and ten are in unemployment.Conclusion. – The amputation of lower limb constitute a major handicap which involves a functional and professional incapacity. We can reduce the risk of this incapacity by a good and appropriate rehabilitation. [Copyright &y& Elsevier]

Report of a rare case concerning an elderly man (81 years) suffering from a leiomyosarcoma of the leg already metastasized to the lungs, discoverded in connection with a suspected thrombophlebitis. This sarcoma developped from the smoth muscle of a leg vessel, probably a vein. Leiomyosarcoma is a malignant mesenchymal tumor of specialized connective tissu, with a strong potential for local proliferation and metastatic spread. It usualy involves the uterine muscle or the wall of the digestive tract, as well as the large vessels of the abdomen and thorax, the prostate very seldom, and only exceptionally a peripheral vein as in this case. The diagnosis suggested by imaging techniques (in particular MRI) is first and foremost immunohistochemical. The treatment is surgical when possible, associated with radiotherapy and chemotherapy as appropriate. The prognosis is especially poor when the diagnosis is made at the metastatic stage. [Copyright &y& Elsevier]

The fasciomusculocutaneous flap at the leg (FMC) include a muscle strip in the classic dissection of the fasciocutaneous flap (FC); this muscle survives only by the musculocutaneous vessels perforators. This muscle improves the trophic quality of the classic FC flap and allows him to bring easily muscle to the lower third of the leg and sole of the foot. From october 96 to january 2001, 9 posterior FMC flaps have been used in 9 men, their ages were between 22 and 61-years-old, 8 of these flaps were distally based and 1 was proximally based. The muscle strip came from the medial gastrocnemius muscle, its lengh and its width corresponded to the dimension of this muscle but the depth has never exceeded 10-12 mm. The skin defects have a diameter ranging from 7 to 10 cm and were localised in 3 cases in the sole of the foot, in 5 cases in the lower third of the leg with 1 case of tibial osteomyelitis and in 1 case in the external part of the knee. All these defects were secondary to trauma. No complications were reported with this technique. There was no vascular problems with the muscle strip: its bleeding was checked at the operating room and at 3 weeks when the pedicle was severed. All these patients were hospitalized between 4 and 5 weeks. With an average of 30 months follow-up all the defects covered were very satisfying and the case of the osteomyelitis was healed. There is no functional sequellae and the aesthetic sequellae are those of the classic FC flaps at the leg. [Copyright &y& Elsevier]