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The article focuses on melanoma, the most aggressive form of skin cancer, discussing its prevalence, risk factors such as sun exposure, genetic predisposition, and how it is diagnosed. It also covers various treatment options for melanoma, including surgical excision for early-stage cases and advancements in targeted therapies and immunotherapies for advanced melanoma, highlighting the importance of early detection and ongoing research in overcoming treatment challenges.

The article focuses on melanoma, the most aggressive form of skin cancer, discussing its prevalence, risk factors such as sun exposure, genetic predisposition, and how it is diagnosed. It also covers various treatment options for melanoma, including surgical excision for early-stage cases and advancements in targeted therapies and immunotherapies for advanced melanoma, highlighting the importance of early detection and ongoing research in overcoming treatment challenges.

Vasectomy is a minor surgery that involves cutting and blocking the vas deferens that carry sperm from the testicles. The choice of surgical techniques to use is currently based on evidence. Local anesthesia provided with mini-needle or with a needle free injection with a jet gun device minimizes pain during anesthesia and surgery. The no-scalpel technique for isolating and exposing the vas deferens (referred to as the no-scalpel vasectomy) reduces the risk of bleeding and infection compared to the traditional incisional technique. Cauterization of the vas deferens mucosa combined with interposition of the fascia over the prostatic segment of the vas is associated with the lowest risk of early recanalization and failed vasectomy. The risk of failure associated with the classic occlusion technique by ligatures and excision of a short segment of the vas is unacceptable. Potentially reversible vas deferens occlusion techniques are under development. [ABSTRACT FROM AUTHOR]

Uterus transplantation (UTx) is the first treatment offered for treating absolute uterine factors of infertility. It is also the first organ transplantation that is bound to be transitory - for the duration of 1 to 2 pregnancies - proposed for a non-vital indication, the ability to carry a child and give birth. If UTx is still at the experimental stage, today more than 70 transplants have been performed worldwide. The first in France was performed by our team at Foch hospital in 2019. It allowed the birth of a healthy baby girl in 2021. A state of the art allows us to analyze the steps necessary for the success of the transplant from the selection of donors (D) and recipients (R) to surgery, immunosuppressive treatment and pregnancy. The procedure is still complex and involves risks of failures and complications. We discuss here potential developments and future prospects, including likely simplifications of the surgical procedure. The ethical issues raised by UTx are also discussed. In the years to come we will know if UTx is destined to enter the field of current specialized infertility practices. [ABSTRACT FROM AUTHOR]

Spine surgery implies minor and major intervention. The aim of our study was to describe the specific aspects related to the practice of anesthesia for spinal surgery in our context. It was a descriptive and prospective study cartied over a year for all cases of spine surgery. The variables studied were the epidemiological,clinical and topographical aspects of patients operated for spine surgery at the military hospital during the study period.Fourty-seven patients were included with a male predominace notably 34 patients (72.3%) and a sex ratio of 2.61. The mean age was 46.53±15.89 years. The petients installation included genupectoral position(n=6, 12.8%), supine position (n=11, 23.4%) and prone position (n=30, 63.8%). Concerning the ASA classification, 59.6% (n=28) of patients were ASA 1 and 40.4%(n=19) were ASA 2. The average blood loss was 517.02±196.78 ml. The average time of surgery was 168.68±77.27 minutes. The indications of spine surgery are diverse.Anesthesia must be adapted considering key aspects such as the surgical technique, patient position and bleeding management. [ABSTRACT FROM AUTHOR]

When their treatment is not optimal, deep cervical burns often develop retractions, ranging between simple vertical retractions to major global ones. They generate functional, aesthetic and psychological sequelae. Surgical treatment, adapted to both the patient and the type of retraction, has several goals including restoring the neck-chin angle, restoring a correct aesthetic aspect, and allowing social rehabilitation. In our unit, we managed 47 patients (mean age 22) with neck contractures over 8 years, from 2012- 2020. Scald is more frequent in children while flame burns prevail in adults. Most (58%) patients healed spontaneously. Moderate and severe contractures (Achauer's classification) accounted for 30.6 and 38.8% respectively. In most (94%) patients, the contracture leads to a distortion of the neck-chin angle and limits the extension of the neck. Surgery techniques were skin grafts (67.3%), local plasties (24.5%) and flaps (8.2%). During the follow-up, results were considered as good in 83%, acceptable in 8.5%, while 8.5% needed another surgery. Plasties (Z, IC, VY...) and local flaps (with or without skin expansions) are indicated in minor contractures. Authors still debate on the best technique (graft or flap) for severe and major ones. Post-operative rehabilitation is a cornerstone for good results. [ABSTRACT FROM AUTHOR]

Esophagectomy for cancer is a surgery associated with an overall morbidity greater than 50%. Hybrid or total minimally invasive esophagectomy result in lower severe complications, lower postoperative pain and better postoperative quality of life, leading to a shorter functional recovery and length of hospital stay. Nevertheless, mini-invasive esophagectomy is a demanding procedure, especially for the thoracic part and the intra-thoracic anastomoses. It is requiring a long learning curve, and a large number of procedures that may limited the widespread of minimally approach for all esophagectomy. The surgical robot has several advantages including a high- definition 3D vision controlled by the surgeon and articulated instruments that improve surgical ability, especially for inexperienced surgeons in laparoscopy. Robotic systems may contribute to implement minimally invasive approach for complex procedures such as esophagectomy. Robot-assisted minimally invasive esophagectomy is associated with a reduction of overall surgery and cardiopulmonary complications compared to open surgery with similar oncological outcomes. The benefit of the robotic approach over the conventional minimally invasive approach is being evaluated. The robotic approach may improve lymphadenectomy and increase the rate of complete macroscopic resection in locally advanced tumor. It also could increase the feasibility and safety of intra-thoracic anastomoses with minimally invasive approach. The robotic system appears to promote the development of major innovations and secure surgical procedures. This mini-review is an update of the main data published in the literature that have evaluated the robot-assisted-minimally-invasive esophagectomy in esophageal cancer. [ABSTRACT FROM AUTHOR]

This study aimed at reporting the epidemiological, diagnostic and therapeutic aspects of urethral prolapse in young girls. This was an observational, descriptive, retrospective study conducted in the Urology Department of the Zinder National Hospital between 2014 and 2021 on 11 cases of urethral prolapse in young girls. The mean age of the patients was 5.81 years, (ranging from 3 to 9 years). The presenting complaint was genital haemorrhage in 10 cases and a request for medical expertise for suspected sexual abuse in one case. Management was medical in one case and surgical in 10 cases. The surgical technique was excision of the prolapsed mucosa followed by a muco-mucosal suture on a Foley catheter. The urethral catheter was removed three days after surgery and the patients were discharged after passive voiding trials the catheter. No complications were recorded. Although being a rare condition, easily diagnosed clinically, urethral prolapse remains unknown to many practitioners in rural areas, thus delaying its management. The classic and definitive treatment is surgical by complete excision of the prolapsed mucosa. Surgical outcome in the short and long term is satisfactory. [ABSTRACT FROM AUTHOR]

Anterior shoulder instability following traumatic dislocation in young adults is a common complication. The Latarjet procedure is the most widely used technique for treating this instability. It is based on coracoid abutment repair of the anterior edge of the glenoid. However, joint exposure during this surgical technique is often limited and makes it difficult to position the abutment. The purpose of this study was to evaluate the result of coracoid abutment procedure on functional outcome in the short and medium term. We assessed the positioning of the coracoid abutment on standard postoperative X-rays and the functional outcome according to Duplay score as well as the satisfaction rate in 70 patients. The average age of patients was 25 and a half years, the sex-ratio was nine, and the mean follow-up period was 6.5 years. Radiological examination showed that coracoid abutment was in subequatorial or non-flush position with respect to the anterior glenoid rim (too internal or protruding in intra-articular position) in 20% of cases. This group showed a drop in mean stability score by 7.68 points, in pain by 10.04 points and in Duplay’s overall score by 13.3 points as well as a significant increase in the level of glenohumeral arthrosis. This study highlights that coracoid abutment in subequatorial or non-flush position has deleterious effect on the functional outcome of the Latarjet procedure. [ABSTRACT FROM AUTHOR]

Introduction: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures. Methods: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications. Results: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery. Conclusion: combined lumbar plexus- sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia. [ABSTRACT FROM AUTHOR]

Résumé: La scoliose idiopathique est le trouble rachidien le plus fréquent chez l'enfant et l'adolescent. Son incidence est de 3 %, plus fréquente chez les filles. La prise en charge a fait l'objet de recommandations de la Haute Autorité de Santé en 2005 et de la Société scientifique internationale sur le traitement orthopédique et de rééducation de la scoliose (SOSORT). Le but ultime de la prise en charge est de ralentir ou d'arrêter la progression de la courbure. Pour cela un dépistage et une prise en charge précoces sont nécessaires. Cette étude a été réalisée auprès des médecins généralistes de l'ex-région Midi-Pyrénées de septembre à novembre 2017. On pourrait améliorer la communication autour des recommandations et du suivi. Idiopathic scoliosis is the most common spinal disorder in children and adolescents. Its incidence is 3%, more common in girls. Management was the subject of recommendations from the HAS in 2005 and the International Scientific Society on orthopedic treatment and scoliosis rehabilitation (SOSORT). The ultimate goal of management is to slow or stop the progression of the curvature. To do this, early detection and treatment are necessary. This study was carried out with general practitioners in the former Midi-Pyrénées region from September to November 2017. We could improve communication around recommendations and follow-up. [ABSTRACT FROM AUTHOR]

Lumbosciatica is a public health problem because of its socio-professional impact. The purpose of our study is to evaluate the indication for surgical treatment and the role of each technique used. We conducted a retrospective study in the Department of Or thopaedics in Tataouine. The study involved 44 patients with common lumbosciatica and having undergone surgical treatment over the period from 2013 to 2018. The information sheet included the epidemiological data and the clinical data. The patients underwent radiological assessment including lumbar spine x-ray (frontal and lateral views) and lumbar computed scan (CT) scan which clarified the cause of sciatica. Surgical treatment was indicated after medical treatment failure, in patients with hyperalgesia and in patients with neurological complication. In our study, herniated disc was the primary cause of lumbosciat ica (50% of cases) followed by lumbar spinal stenosis (25%), spondylolisthesis (22.7%) and transverse mega-apophysis of L5 vertebrae (2.3%). Traditional discectomy was the most used technique for surgical treatment of herniated disc. Eight patients had spondylolisthesis. They underwent laminectomy associated with posterior arthrodesis. Lumbar spinal stenosis was treated with laminectomy alone in 54.54% of cases. Outcome was favorable during the follow up period in 90% of cases (Visual Analog Scale 3±1 at follow-up). Surgical technique depends on etiology and imaging data on which to base the choice of arthrodesis stages. [ABSTRACT FROM AUTHOR]

We report the case of a 22-year-old female patient, with no particular previous history, who had nevus progressively increasing in volume since birth. Physical examination revealed a huge bluishgrey mass in the left fronto-temporal-parietal region, extending beyond the midline, infiltrating the palpebral region with orbital extension and blindness in the left eye (A). Another isolated nevus was found in the occipital region, which measured 5cm along its longer axis. Craniofacial CT scan with IV contrast showed nevus extension into the left intraorbital region and infiltration of the scalp opposite the nevus, without involvement of the brain parenchyma. A 3-stage surgical procedure was performed, in the first stage two expanders were placed in the healthy occipital and contralateral parietal region. In the second stage, the entire parieto-temporo-occipital component was removed, the frontal component was reduced and the scalp, which had gained enough elasticity thanks to the expanders, was reconstructed using transposition flaps (B). The third stage consisted of resection of the remaining upper fronto-palpebral component and part of the orbital component with repair by total skin graft to cover any loss of substance (C). The result obtained was extraordinary and the patient was so happy to be able to live a normal life. [ABSTRACT FROM AUTHOR]

Mohs micrographic surgery (MMS) is a technique allowing for intraoperative histologic assessment of surgical margin of malignant tumors. This study aims to highlight the role of MMS in the achievement of radical healing of basal cell carcinoma (BCC) in our patients. We conducted a study of 29 patients with basal cell carcinoma of the face over a period of 5 years. The median age of patients was 45.8 years (12-80). The sex-ratio M/F was 1.23. One-stage surgical procedure was sufficient to obtain complete resection in 51% of cases. Three-stage surgical procedure was needed in 14% of the cases. The mean duration of one-stage surgical procedure was 1 hour. No complications were reported in the postoperative period and sequelae were simple. The aesthetic and functional result was satisfactory. No recurrence was noted. BCC accounts for approximately 80% of all skin cancers. The decision to use MMS to treat BCC is based on three variables: the seat and the size of the tumor, its histological appearance with the identification of resection margin and its recurrent nature. MMS is currently the most effective method in the treatment of BCC and allows maximum healthy tissue preservation. It is a safe and repeatable surgical procedure based on team work and adapted to the treatment of patients with BCC who are at high risk of recidivism. The aesthetic and functional results are satisfactory. Recurrence rate at 5 years is 10 times lower than with the other methods. [ABSTRACT FROM AUTHOR]

Tarlov cyst or perineural cyst is a local dilation of the subarachnoid space formed within the nerve root and filled with cerebrospinal fluid. There is no consensus on the best treatment of syntomatic sacral perinervous cysts. Many methods have been used to treat these symptomatic lesions, with variable results. We report a case series including 20 patients undergoing surgery for sacral Tarlov cyst. Our results were satisfactory; 80% of patients improved without neurological worsening in the post-operative period. Our surgical technique (sacral laminectomy+cyst puncture+establishment of dural sheat) described for the first time in this study seems to have been effective in the 20 cases reported in our study. [ABSTRACT FROM AUTHOR]

We report a series of seven cases of fractures of the distal end of the femur treated by retrograde centro-medullary nailing in the Orthopedic- Trauma Department at the Hospital Ibn Sina over the period 30/05/2010 - 30/04/2015. The average age of patients was 54 years, with a slight male predominance (57,1%). Road traffic accidents were the main cause of these fractures (71.4%) and they mostly affected the right side of body (57,1%). From a surgical point of view, the mean time between symptom onset and treatment initiation was 2 days. Spinal anesthesia was performed in five cases. The average length of stay in hospital was 5 days. The mean time of consolidation was 4 months in all patients, there was only one case of delayed consolidation (6 months). Patients had good functional outcomes with mean knee flexion 120°, with only one case of limited flexion 90°. There was one case of consolidation delay and one case of pseudarthrosis. No deaths, or superficial or deep sepsis, or thromboembolic complications or fat embolism were registered. In general we had satisfactory outcomes. Our study highlights that retrograde femoral nailing is an essential osteosynthesis technique for the surgical treatment of the distal femur fractures. [ABSTRACT FROM AUTHOR]

Surgical resection of bubbles or bullectomy is the gold standard in the treatment of bubbles arising from pulmonary emphysema. It is usually indicated for patients with complicated bubbles or when they are the underlying cause of disabling dyspnea. This study aims to determine the indications for bullectomy and to evaluate surgical outcomes in our Department. We conducted a retrospective, descriptive study of 24 patients (23 men and 1 woman) whose average age was 49 years and who had undergone bullectomy between 2004 and 2013. Collected data were: factors favoring the occurrence of bullous emphysema, the circumstances in which bubble was detected, data from the radiological examinations, data from pulmonary and cardiovascular function testing, data from bullectomy, data from postoperative clinical and functional examination. Morbidity rate was 37.5 %. The main complication was persistent air leak (7 cases). One patient died two days after surgery due to acute respiratory failure. The average followup period was 26 months during which we observed improvement of dyspnea in all patients and no complications. Bullectomy is an effective, reliable and safe surgical technique that may improve patients' quality of life for a few years. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: L’invagination intestinale aiguë (IIA) du nourrisson et de l’enfant est une urgence médico-chirurgicale considérée comme saisonnière, avec une prédominance automno-hivernale. En France, les caractéristiques épidémiologiques de l’IIA ne sont pas bien connues. Patients et méthodes: Une étude rétrospective sur 10ans (janvier 2002–décembre 2011) a colligé les IIA iléocoliques idiopathiques prises en charge dans un service d’urgences et de chirurgie pédiatrique. L’objectif principal était d’évaluer la saisonnalité de l’IIA. Le sex ratio, la répartition selon l’âge, le taux de récidive, le taux d’échec du lavement thérapeutique ont également été étudiés et définis. Résultats: Trois-cent-six cas d’IIA iléocolique primitive certaine ont été colligés (280 patients), le nombre de cas annuels médian étant de 31 [21–42]. La répartition mensuelle cumulative des cas n’était pas significativement différente au cours des 12 mois de l’année, ne révélant aucune prédominance automno-hivernale : 24 % des cas en automne, 21 % en hiver, 29 % au printemps et 27 % en été (p =0,6). Deux pics ont été observés en avril (35 cas) et en juin (34 cas). L’âge médian des enfants des deux sexes était de 18,7 mois [extrêmes 2,3–159,4 mois], 19,5 mois [3–159,4] pour les garçons, et 14,8 mois [2,3–77,5] pour les filles (p =0,02). Deux pics ont là aussi été mis en évidence, entre six et neuf mois et entre 18 et 21 mois. Le sex ratio était de 2 (p =0,0003), avec une tendance à l’augmentation avec l’âge. Le taux de récidive (n =26) avait été égal à 8,2 % pour l’ensemble des patients : 10 % chez les garçons et 5 % chez les filles (p =0,08). Le taux d’intervention chirurgicale après échec de lavement avait été de 7,5 % (n =21), sans récidive post-opératoire. Conclusion: Contrairement à ce qui est classiquement décrit, nous n’avons pas mis en évidence de caractère saisonnier de l’IIA idiopathique. Nos résultats sont concordants avec les données de la littérature. Il nous paraît pertinent d’envisager une étude plus large et peut-être une mise à jour de l’enseignement fait aux étudiants en médecine. [ABSTRACT FROM AUTHOR]

Résumé: Les grandes pertes de substance osseuse de l’avant-bras posent un difficile problème de reconstruction, principalement lorsqu’elles sont anciennes. La technique de Watson-Jones permet d’obtenir par un geste, plus simple que les autres techniques plus sophistiquées, un avant-bras solide et utilisable dans la vie courante malgré le sacrifice de la pronation-supination. Nous rapportons un cas (qui nous semble rare et original) d’une pseudarthrose avec perte de substance étendue du radius évoluant depuis plusieurs années, traitée par la technique de « l’avant-bras à os unique » (one-bone forearm) qui a permis de redonner au patient une fonction et un aspect esthétique acceptables. [ABSTRACT FROM AUTHOR]

Résumé: Durant un stress chez l’homme, la communication entre le système nerveux central et le système immunitaire est primordiale pour préserver l’homéostasie de l’organisme. Le principal système neuroendocrinien impliqué dans cette interface est l’axe hypothalamo-hypophyso-surrénalien (HHS), qui via la synthèse des glucocorticoïdes, va moduler l’intensité de la réponse inflammatoire. Les agents hypnotiques interfèrent avec le fonctionnement de cet axe HHS qui va être activement mobilisé dans le contexte d’un acte chirurgical. Même si l’étomidate reste actuellement le médicament au centre des discussions, il semble, qu’au moins expérimentalement, la majorité des hypnotiques a la capacité de moduler la synthèse des stéroïdes surrénaliens. Néanmoins, au vu de la littérature abondante sur le sujet, il semble que l’étomidate soit l’agent hypnotique le plus délétère sur le bon fonctionnement de l’axe HHS et que son utilisation doit être limitée dans les contextes où le fonctionnement de cet axe soit déjà altéré. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer les connaissances théoriques et pratiques sur les cathéters intraosseux (CIO) chez l’adulte en France en 2012. Type d’étude: Étude observationnelle descriptive transversale nationale de type enquête d’opinion et de pratique. Matériels et méthodes: Un courriel, avec un lien vers un questionnaire automatisé en ligne, a été adressé aux médecins et internes en poste dans les services d’anesthésie, de réanimation et de médecine d’urgence de France. Les questions posées portaient sur les connaissances théoriques et l’expérience pratique de l’utilisation de dispositifs intraosseux. Résultats: Sur les 1359 réponses obtenues, 396 (29 %) praticiens avaient déjà utilisé un CIO, principalement en cas d’ACR (68 %). L’assurance des opérateurs et la proportion de médecins ayant déjà posé un CIO augmentaient avec les années d’expérience. Les raisons justifiant le non-recours à cette voie étaient principalement l’absence de difficulté à la pose d’une voie veineuse périphérique (77 %) et la méconnaissance du matériel et de la technique (32 %). Plus de la moitié (n =753 [55 %]) des praticiens avaient reçu une formation et 90 % (n =265) des médecins non formés la jugeaient nécessaire. Les systèmes motorisés étaient majoritairement utilisés (71 %). Conclusion: Seulement 29 % des praticiens français interrogés déclaraient avoir déjà mis en place un CIO. Avec l’avènement des dispositifs les plus récents, une formation théorique et pratique s’avère indispensable pour l’essor de la technique. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: Les techniques de reconstruction mammaire autologue obtiennent les meilleurs résultats cosmétiques. La satisfaction esthétique est un critère d’évaluation important. L’indication repose sur des critères techniques (morphologiques, antécédents médicaux) et sur les souhaits de la patiente. Une évaluation rigoureuse des résultats est nécessaire afin d’aider les patientes dans leur choix de reconstruction. Méthodes: Cette étude a concerné 33 DIEP et 27 grands dorsaux. Un questionnaire de satisfaction a été envoyé aux patientes afin de recueillir l’évaluation esthétique de leur poitrine reconstruite, les séquelles au niveau du site donneur, ainsi que leur satisfaction générale. Les photographies postopératoires des patientes ont bénéficié d’une évaluation esthétique par deux groupes d’observateurs. Les complications ont été analysées. Résultats: Le DIEP tend à obtenir une meilleure satisfaction esthétique en ce qui concerne la symétrie de la poitrine et le volume du sein reconstruit (p =0,05), ainsi qu’une meilleure satisfaction générale (p =0,02). L’homogénéité de couleur du sein reconstruit a été jugée supérieure par les observateurs dans le groupe grand dorsal (p =0,005). La cicatrice du prélèvement du DIEP a été jugée plus inesthétique, tandis que celle du grand dorsal a été jugée plus douloureuse (p = 0,04) et gênante, avec plus fréquemment des anomalies de contour (p =0,03). Nous avons déploré deux nécroses totales et trois partielles dans le groupe DIEP, ainsi que deux nécroses partielles dans le groupe grand dorsal. Conclusion: Cette étude apporte des éléments pouvant orienter la patiente et le chirurgien dans le processus complexe de décision thérapeutique, sans dispenser ce dernier d’une sélection rigoureuse des indications. [ABSTRACT FROM AUTHOR]

Résumé: Contexte: La réduction mammaire est l’une des opérations les plus fréquentes en chirurgie plastique. L’objectif principal de cette étude était de décrire les complications dues à la réduction mammaire, et de déterminer les facteurs de risque. Méthodes: Notre étude rétrospective concernant 715 seins opérés entre 2004 et 2009. Les analyses statistiques ont été réalisées avec des analyses bivariées et analyse multivariée. Résultats: Le tabagisme, le poids de résection et la présence de vergetures étaient les trois facteurs de risque associés à des complications après une réduction mammaire. Le tabagisme a également été associé à un risque élevé de cicatrices hypertrophiques. L’indice de masse corporelle n’a pas été associé à un risque de complications générales, mais à un risque de désunion. Le pédicule supérieur et le Thorek ont présenté un taux de complications plus élevé que les techniques de pédicule postéro-supérieure et postéro-inférieure. Conclusions: Ces résultats nous incitent à retarder les réductions mammaires chez les patients obèses et fumeurs. Ces résultats incitent également à choisir une technique chirurgicale avec une sécurité optimale en termes de sécurité vasculaire. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: Le cancer du sein peut s’étendre à la paroi thoracique. Il s’agit d’un stade agressif de mauvais pronostic. Nous avons développé une technique de pariétectomie thoracique élargie dépassant l’aire mammaire dans le but de diminuer les récidives carcinologiques. Patients et méthodes: Il s’agit d’une série rétrospective monocentrique de 33 patientes présentant un cancer du sein étendu à la paroi thoracique sans métastase dont 13 patientes présentaient un cancer du sein primaire et 20 présentaient une récidive d’un cancer du sein. Le traitement réalisé par un même opérateur consistait en une pariétectomie thoracique élargie, emportant la peau, le tissu sous-cutané, la glande mammaire et les muscles pectoraux, avec des marges minimales de 4cm à distance des lésions macroscopiquement visibles. L’analyse des résultats concernant cette technique a été réalisée par un autre opérateur. Résultats: Les patientes étaient âgées en moyenne de 55ans. Les pièces d’exérèse mesuraient de 350cm2 à 1200cm2, et la durée moyenne de cicatrisation totale était de 7,9 mois. La complication principale était la chondrite. Le délai de suivi moyen était de 122 mois (6 mois–240 mois). La survie à 1an était de 84,4 %, à 2ans de 72,6 %, à 3ans de 69,5 % et à 5ans de 66,4 %. Conclusion: La technique de pariétectomie thoracique élargie est une technique simple, reproductible permettant une amélioration de la survie. Le cancer du sein avec extension pariétale a un pronostic péjoratif. Au terme de cette étude, 20 des 33 patientes ayant bénéficié de cette technique sont toujours en vie. [ABSTRACT FROM AUTHOR]

Résumé: La couverture des pertes de substance cutanées palmaires est parfois difficile en urgence et fait appel à différents types de techniques de chirurgie plastique. Nous rapportons le cas d’un patient de 41ans, victime d’un accident de travail par écrasement de la main droite avec d’une perte de substance cutanée palmaire étendue. Les différents lambeaux utilisés en pratique courante étaient contre-indiqués ou non utilisables. Nous avons alors opté pour un lambeau synovial du fléchisseur superficiel des doigts, décrit initialement par Wulle pour la couverture du nerf médian dans les syndromes du canal carpien récidivants, afin de prévenir la fibrose cicatricielle. Nous discutons les options de couverture dans les pertes de substance cutanées palmaires post-traumatiques prises en charge en urgence, ainsi que l’utilité du lambeau synovial du fléchisseur superficiel des doigts dans ces indications. Ce cas clinique montre que le lambeau synovial peut être une alternative intéressante dans les pertes de substance cutanées palmaires. [ABSTRACT FROM AUTHOR]

Résumé: Le traitement chirurgical de la compression du nerf ulnaire au coude donne de bons résultats dans la majorité des cas, mais on observe parfois des résultats incomplets ou des récidives qui peuvent conduire à des interventions itératives. Cette chirurgie itérative entraîne des séquelles douloureuses neuropathiques résistant souvent aux traitements pharmacologiques. Dans ces cas rebelles sélectionnés, nous avons fait le choix d’un traitement chirurgical associant une neurolyse du nerf ulnaire avec enveloppement par le lambeau vascularisé de Lamberty et Cormack modifié. L’étude rétrospective a porté sur six cas avec un recul moyen de 30 mois. Les résultats montrent une amélioration de tous les patients, notamment pour les deux critères reflétant le mieux les douleurs neuropathiques : le questionnaire DN4 et l’échelle visuelle analogique de la douleur. Cette série, quoique courte, nous engage à continuer d’appliquer le principe de couverture des neuropathies du nerf ulnaire au coude par un lambeau vascularisé. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer différentes techniques chirurgicales d’ovariectomie partielle pour cryopréservation. Évaluer les conséquences d’une exposition préalable aux traitements cytotoxiques sur la qualité de l’ovaire prélevé. Patientes et méthodes: Étude observationnelle rétrospective unicentrique, sur 4ans, des femmes ayant eu une chirurgie pour cryopréservation ovarienne pour chimio ou radiothérapie à haut risque de faillite ovarienne précoce. Plusieurs techniques d’ovariectomie partielle ont été proposées : avec clampage du pédicule vasculaire gonadique (prélèvement indirect), sans clampage (prélèvement direct) et à la pince agrafeuse automatique. Le tissu ovarien était immédiatement préparé pour la cryoconservation en salle d’opération. L’ensemble du prélèvement était divisé en petits fragments. Pour chaque ovaire, un compte des fragments était effectué. Un fragment était examiné afin de déterminer le nombre de follicules primordiaux. Résultats: L’ovariectomie et la cryopréservation ont été réalisées chez 13 patientes. Deux évènements hémorragiques sont survenus avec la technique directe, sans conséquence pour les patientes. Le nombre de fragments obtenus avec les techniques indirecte et directe était de respectivement 19 vs 15, p =0,18 ; le nombre de follicules primordiaux était de 38 vs 36, p =0,87. L’agrafeuse automatique consommait trop de tissu ovarien pour être intéressante. Il y avait moins de fragments, 15 vs 20, p <0,05 et de follicules primordiaux, 35 vs 40, p =0,65, après une première cure de chimiothérapie. Discussion et conclusion: La technique avec clampage vasculaire est plus sûre mais sans différence sur la qualité du prélèvement. Une seule cure de chimiothérapie a un impact péjoratif sur la qualité du prélèvement. [ABSTRACT FROM AUTHOR]

Résumé: Les reconstructions labiales peuvent être réalisées par des techniques chirurgicales bien définies, qui sont particulièrement nombreuses. Le but de cet article est de revoir les différentes techniques usuelles en insistant sur les détails techniques facilitant la pratique et permettant les résultats les plus esthétiques. Parallèlement seront vus les écueils à éviter dans cette chirurgie dont le but reste fonctionnel et esthétique. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Comprendre les principes qui guident les choix des différentes techniques chirurgicales utilisées dans le traitement chirurgical des pubalgies. Actualités: Depuis Nesovic, de très nombreuses publications parlent du traitement chirurgical des pubalgies. Comment en pratique avoir une démarche rationnelle et proposer au sportif une intervention fiable, tel est le défi à relever. Après avoir recherché la cause des pubalgies, et devant l’échec des mesures conservatrices, deux types de chirurgie peuvent être proposées, isolées ou associées : le renforcement de la paroi abdominale ou la ténotomie des adducteurs. Le renforcement de la paroi va utiliser les techniques de réparation pariétale utilisées dans les cures de hernie. L’utilisation de prothèse est pour nous contre-indiquée chez le jeune sportif car c’est une technique pourvoyeuse de douleurs chroniques. Les techniques de suture sont préférables, selon l’inventaire des lésions, une réparation en quatre épaisseurs selon Shouldice ou en deux épaisseurs selon Muschaweck est effectuée. La ténotomie des adducteurs traite l’enthésopathie des adducteurs, le risque d’adhérences postopératoires impose une mobilisation précoce et de tous les instants. Il n’y a pas de consensus pour le traitement des ostéo-arthropathies pubiennes, les gestes chirurgicaux directs sont peu efficaces et grevés de complications invalidantes, la mise au repos de la symphyse par l’association d’un renforcement pariétal et d’une ténotomie est préconisée. Conclusion: Aucune étude prospective de niveau de preuve 1 ou 2 existe, permettant de choisir la meilleure solution chirurgicale. Il s’agit donc d’EBM (expert based medicine et non d’evidence based medicine) qui permet de choisir la meilleure solution en tenant compte de l’expérience acquise et de la maîtrise des différentes techniques. [ABSTRACT FROM AUTHOR]

Solitary fibrous tumor is a benign soft tissue tumor fibroblast. Several locations have been reported with oral rate those with a rate of 3% in the mouth. The etiology is still unknown, but the authors have described a history of trauma. We report in this paper a case of solitary fibrous tumor occurring in the left cheek, which occurred in an elderly patient of 58 years. The excision of the tumor under local anesthesia allowed the pathological examination, which diagnosed a solitary fibrous tumor. [ABSTRACT FROM AUTHOR]

Résumé: Propos: Analyser les résultats du système de gestion et d’analyse des publications scientifiques (SIGAPS) au sein de l’Assistance publique–Hôpitaux de Paris (AP–HP) et comparer la production scientifique entre les différentes disciplines médicales et chirurgicales du CHU de Paris. Méthodes: Toutes les publications importées par SIGAPS depuis PubMed entre 2006 et 2008 ont été incluses. Les données suivantes ont été prises en compte et analysées : service hospitalier d’origine, nombre d’articles publiés, nombre de titulaires dans l’unité, score SIGAPS. Résultats: Au total, 38 709 publications ont été analysées. Les 747 services étaient composés de 5719 titulaires (1895 [33,1 %] PU–PH, MCU ou PHU ; 2772 [48,4 %] PH et 1052 [18,4 %] CCA ou AHU). Le nombre moyen de titulaires par service était de 7,7±6,7 (min-max : 1–69). La moyenne du nombre total de publications par service était de 51,8±49,4 (min-max : 1–453). Le score SIGAPS moyen était plus important en médecine qu’en chirurgie (621,2±670,1 vs. 401±382,2 ; p =0,01) mais pas le nombre moyen d’article par titulaires entre ces deux filières (8,1±8,3 en médecine vs. 6,6±6,2 ; p =0,08). Le nombre de moyen de publication par temps plein était de 7,9±7,8 (1–45), soit un nombre moyen de 2,7±2,6 par temps plein et par an. Conclusion: L’AP–HP a une production scientifique relativement importante mais avec un nombre moyen de 2,7 articles par temps plein par an. Il n’existait pas de différence notable entre les disciplines médicales et chirurgicales. [ABSTRACT FROM AUTHOR]

Abstract: The risk of infection is increased in patients treated with glucocorticoids, especially in those taking long-term and high dosage treatment. However, there is little valid practice for the prevention of infections in this patient population. The risk of reactivation or worsening of a latent infection (e.g., hepatitis B, tuberculosis, strongyloidiasis) is proved and individual reflection should be conducted in at-risk patients. Preventions of Pneumocystis jiroveci or upper urinary tract infections are considered differently according to practitioners’ habits and their specialties. Adequate prevention should be prescribed in glucocorticoid-treated patients who have been in contact with varicella zoster or measles virus. Many vaccines could be prescribed in those people but live vaccines should be avoided. A consultation of travel medicine should be systematically proposed before a travel in intertropical zone. Anti-inflammatory and stimulant properties of glucocorticoids are frequently misused in order to improve sport performances. All glucocorticoids are considered as performance-enhancing drugs. Their prescription should therefore be adapted to the laws in force in the sport. By reducing vomiting and pain, glucocorticoids may be beneficial in patients undergoing surgery. However, in people prescribed long-term glucocorticoid therapy, the risk of postoperative adrenal insufficiency has to be considered, even though very few data are available on this topic. Oral contraceptives or intra-uterine devices are effective contraceptives methods in patients treated with systemic glucocorticoids. [Copyright &y& Elsevier]

Résumé: L’objectif de ce travail était de réaliser une mise au point sur la place de la chirurgie vidéo-assistée en chirurgie viscérale pédiatrique et de discuter ses perspectives d’avenir. Les techniques de vidéochirurgie ont permis de minimiser l’impact esthétique et traumatique des interventions en chirurgie viscérale et sont en constant développement chez l’adulte comme chez l’enfant. Une formation plus précoce des chirurgiens à ces techniques, associée aux progrès anesthésiques et aux améliorations technologiques, a amélioré le savoir-faire, permettant de pratiquer des interventions plus complexes par cette voie d’abord. Si la plupart des interventions viscérales ont déjà été réalisées par voie cœlioscopique, la littérature peine à la définir comme un gold standard, notamment en raison des difficultés à démontrer des bénéfices esthétiques ou de diminution des douleurs. L’intérêt de la cœlioscopie pour la cholécystectomie est désormais admis en termes de suites opératoires sans augmentation des complications. Pour le traitement chirurgical du reflux gastro-œsophagien et pour la splénectomie, aucune étude pédiatrique ne conclut à la supériorité de la cœlioscopie mais des données chez l’adulte la suggèrent. L’abord par lomboscopie permet de réaliser des interventions urologiques en évitant de larges lombotomies. La cœlioscopie peut servir également d’outil diagnostique, comme pour les testicules non palpables, suivi d’un geste thérapeutique si nécessaire. L’appendicectomie par cette technique reste encore sujette à débat. Les études sont contradictoires et la chirurgie ouverte garde une place importante, mais la proportion de cœlioscopie dans cette indication semble augmenter. La cœlioscopie reste controversée pour la chirurgie oncologique pédiatrique. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Acute scrotal pain is a true surgical emergency as patients presenting with acute scrotal pain may suffer from spermatic cord torsion and gonadal loss. We assessed whether the type of consultation (first consultation in our center or secondary transfer from a peripheral hospital or primary care practice), distance from home to hospital, and duration of pain had an impact on the orchiectomy rate. Patients and methods: We retrospectively reviewed the medical records of all patients under 15years of age suffering from acute scrotal pain who had surgical exploration between January 2007 and January 2010 in our center. Patient demographics, transfer status, time to consultation in our center, time to surgery, operative findings and clinical outcome were reviewed. Results: Of the 76 patients with acute scrotal pain in whom surgical exploration was performed, 59 had acute spermatic cord torsion, 16 had torsion of the testicular appendage, and 1 had orchitis. In patients with acute spermatic cord torsion, the median age was 13 years (range: 0.18–14.97). In patients with acute spermatic cord torsion, 32 came straight to our center (direct admission group, 54.2%), and 27 (45.8%) came after a prior consultation out of side the center (transfer group). The median journey was 19km (range: 2.5–113) in the direct admission group and 44km (range: 2.5–393) in the transfer group (P =0.0072). The median time between pain onset and consultation at our center was 4.3h (range: 0.5–48) in the direct admission group, and 11h (range: 2–48) in the transfer group (P =0.6139). The median time between admission at our center and surgery was 2.5h, with no difference between the 2 groups (P =0.8789). The orchiectomy rate was 25% in the direct admission group and 14.8% in the transfer group (P =0.5177). In children who underwent orchiectomy, the duration of pain was consistently over 6h. The duration of pain was greater in patients with orchiectomy (12h [range: 1–72]) than in patients without orchiectomy (12h [range: 6–48]; P =0.0001). Conclusion: In this study, the orchiectomy rate depended on the duration of pain but not on transfer status. Acute scrotal pain must lead to surgical exploration as soon as possible, requiring close collaboration between peripheral hospitals, primary care physicians, and referral centers. [Copyright &y& Elsevier]

Résumé: Objectif: Les techniques chirurgicales décrites de nymphoplastie de réduction sont multiples et variées. À travers une revue de la littérature, nous avons essayé de déterminer quelle est la technique à privilégier afin de traiter les hypertrophies des petites lèvres. Matériel et méthodes: Une revue de la littérature a été effectuée en consultant la base de données Medline (entre 1980 et 2012). Les articles ont été sélectionnés en croisant les mots clés ű hypertrophy of labia minora Ƈ et ű surgical reduction of labia minora Ƈ. Résultats: Aucun essai randomisé n’a été retrouvé. Seules deux techniques (de résection sectorielle triangulaire) ont fait l’objet de séries rétrospectives portant sur des effectifs importants avec un suivi à long terme détaillé. Discussion et conclusion: Les techniques de nymphoplastie de réduction décrites sont multiples. La technique de résection triangulaire est la seule ayant fait l’objet d’une évaluation sur de grands effectifs, avec des résultats satisfaisants sur le plan esthétique et fonctionnel (90 à 95 % des patientes) et peu de complications (2 à 7 %). Les autres techniques, évaluées sur des nombres plus restreints de patientes, rapportent également des résultats satisfaisants. Par conséquent, la technique de résection est à choisir principalement en fonction de l’expérience du chirurgien, des particularités anatomiques et des souhaits de la patiente. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Information technologies appear to be interesting tools to assess and improve professional practices. In that setting, the management of surgical antibiotic prophylaxis represents an appropriate clinical area for using and evaluating such a tool. Despite the existence of guidelines in one hand and the demonstrated interest for a strict application of recommendations in the other hand, some irregularities in the management of surgical antibiotic prophylaxis remain in France in 2010. Objectives: Since we have had computer systems in our department for several years, we performed an evaluation of practice to assess the impact of both the computer-based help and the updating of knowledge in physicians as tools to improve the application of guidelines for surgical antibiotic prophylaxis. Study design: Clinical audits. Methods: Three clinical audits have therefore been performed before an implementation of computer-based help for clinical decisions and a clinical update for physicians, immediately after, and two years after this combined procedure (2322, 2678 and 2863 patients, respectively). Results: There was an enhancement of clinical practices and compliance to guidelines secondary to the beginning of computer-based prescription (55 to 81%, P <0.05). However, a weaning effect was observed with longer intervals between clinical update and surgical procedure, in association with increased omissions of antibiotic prophylaxis. Conclusion: Computer-based help for clinical decision and prescription seems to be a useful tool for surgical antibiotic prophylaxis but it should be accompanied by direct regular educational measures to update protocols and databases. [Copyright &y& Elsevier]

Summary: Webster''s modification of the Bernard cheiloplasty is a well-known technique, usually applied to the reconstruction of total or subtotal amputations of the lower lip following oncological resection. We present three cases of post-traumatic reconstructions with interesting results. [Copyright &y& Elsevier]

Summary: Introduction: Pyoderma gangrenosum (PG) is a rare chronic inflammatory skin disease characterized by the recurring development of necrotizing and painful ulcers and therefore, often misinterpreted. This condition can simulate fulminant infection, particularly after surgery. The presentation is often impressive in extensive ulcerations and scarring and lead to significant sequelae. A rapid initial management avoids a dramatic evolution. Patients and methods: We report the case of three PG for patients followed for breast reconstruction after breast cancer. Discussion: PG is a neutrophilic dermatosis that can occur after injuries of varying intensity. Its shape after surgery is a rare disease whose presentation loud and fast pace “infectious” contrasts with the absence of inflammatory lymphangitis or lymphadenopathy. Be aware of prescribing high doses of corticosteroids. Conclusion: These three cases illustrate the importance for early diagnosis and treatment of PG, who can allow spontaneous healing without complex surgery, always feared in this context. [ABSTRACT FROM AUTHOR]

Summary: The nose is a complex entity, combining aesthetic and functional roles. Descriptive anatomy is a fundamental science that it can be difficult to relate directly to our daily surgical activity. Reasoning in terms of aesthetic subunits to decide on his actions appeared to us so obvious. The aim of this paper is to resume the anatomical bases relevant to our daily practice in order to fully apprehend the restorative or cosmetic procedures. We discuss the limits of the systematization of these principles in nasal oncology. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results. Material and methods: Our study focused on four men whose average age was 27 (age range from 19 to 43). The fractures were type IV according to Melone''s classification. The associated lesions included: one fracture of the base of the ulnar styloid, one fracture of the distal quarter of the ulnar diaphysis and one scapho-lunate diastasis. We used a volar medial approach between the flexors tendons and the ulnar bundle in order to pin the fragment of lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin incision. In two cases, this pinning was complemented with a brachial-antebrachial-palmar cast and in the other two cases with an external fixator. Results: The follow-up period averaged 68.8 (18 to 115) months, all the patients were clinically examined through antero-posterior, lateral and dynamic X-rays. The objective results assessed according to Green and O’Brien''s criteria, later modified by Cooney, were as follows: two very good, one good, one average. The X-rays showed consolidated fractures. According to Knirk and Jupiter''s classification of arthritis, we had three grades 0, one of which showed a subchondral sclerosis of the lunate fossa, and one grade 3. Discussion and conclusion: Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry''s approach, thereby avoiding excessive traction of the median nerve. Type d’étude: Niveau IV. [Copyright &y& Elsevier]

Abstract: Background: The aim of this study is to compare functional and radiological results of two surgical techniques in treatment of proximal humeral fractures. Patients and methods: A prospective study was performed, which included 12 patients operated for a proximal humeral fracture by open reduction and internal fixation using an anatomical humeral plate, and another group of patient (14 patients) treated for the same lesion using a palm tree pinning technique of Kapandji. The comparison of results of the two techniques was based on three parameters: the time of healing, quality of reduction, and the functional result. The global mean age was 48.6 (±13,7), and the sex ratio (M/W) was 1. Results: Statistical analysis of functional and radiological results showed no superiority of one technique over another; so the mean time of healing was 6.1 (± 0.7) weeks in the group treated by plate, and 6 (± 0.7) weeks in the group treated by pinning (P =0.5), the mean absolute Constant score was respectively 86 (±10.4) and 90.92 (±2.5) (P =0.09), and the mean measuring of cephalic angle was respectively 46.91 (±17.68) and 55.71 (±19.48) (P =0.24). Conclusion: Univariate analysis showed no statistically significant association between endpoints and the two surgical techniques studied. Therefore the study showed no statistical superiority of one surgical technique over another. [Copyright &y& Elsevier]

Abstract: The intraosseous ganglion cyst (IOGC) is a benign and lytic bone tumor affecting mostly the metaphyseal and epiphyseal regions of long bones. Its location on the short bones, including the carpal bones has been little reported in the literature. Our review of the literature shows consensus about the surgical techniques to use, but there is currently no real consensus about its pathophysiology, and its diagnostic work-up. Complications related to this lesion (mainly the risk of pathologic fracture) are potentially serious, and can cause irreversible damage. They therefore require accurate assessment to guide the choice of medical or surgical treatment, including a CT scan, which — we believe — is essential. [Copyright &y& Elsevier]

The techniques and the first surgical way moved on with the medical imagery progress. In oral surgery, one principle is to conserve bones volumes. In fact oral surgery should not spoil rehabilitation possibility by prosthesis or surgery reconstruction. The objective of this article is to describe a new way to preserve bone's volumes after a canin extraction even if it's maxillary or mandibular included. In purpose to fill the hole and to limit mucosa invagination, some authors use biomaterials and others prefer realise a bone autologous graft coming from another area. We suggest realization of a bone's part and repositioning secondary after tooth extraction. We present this technique in two clinic cases. [ABSTRACT FROM AUTHOR]

Around 15% of diabetic patients will suffer from a diabetic foot ulcus and subsequent amputation. Prevention and adapted treatment of a foot at risk is important and should be carried out by a multidisciplinary team. A foot at risk needs patient training and adapted footwear. Local wound care and control of vascular status follow. In case of deterioration of the local status surgical debridement and occasionally amputation have to be considered. [ABSTRACT FROM AUTHOR]

Abstract: Background: Transradial intervention of coronary lesion is increasing in frequency and is associated with lower major vascular access site complications. However, the small size of the radial artery is a major limitation of this technique, especially for bifurcation lesions, because 6-French guiding catheters are necessary to optimize the technique. A Sheathless guiding catheter has recently been introduced, optimizing a large lumen with a small size. Objectives: The aim of this study is to report our preliminary experience performing bifurcated transradial interventions using a 6.5 French Sheathless guide catheter. Patients and methods: From March 2009 to February 2012 in three hospitals, 46 consecutive patients were enrolled in this study who underwent transradial approach (TRA) for percutaneous bifurcation coronary interventions using the 6.5 French Sheathless Eaucath guiding catheter system because of small radial artery caliber. Results: In this study, 46 patients were enrolled with mean age of 72.13±16.41 years. The majority of patients were females with sex-ratio 0.53. Procedural success using the 6.5 French Sheathless guide catheter system was 100 % with no cases requiring conversion to a conventional guide and catheter system. During procedures, adjunctive devices used in this cohort included IVUS (2 patients), 35 bifurcated lesions were treated with a kissing-balloon technique in the group of 46 patients undergoing bifurcation PCIs, one patient required rotational atherectomy, thrombus-aspiration catheters had used in four patients, FFR-guided angiography in four patients. We report one case of chronic total occlusion bifurcated lesion successfully treated using this hydrophilic catheter. There were no radial artery site complications. Conclusion: The treatment of coronary bifurcation lesions with 6.5 French Sheathless guiding catheter by transradial approach is feasible and appears safe in this multicenter study. [Copyright &y& Elsevier]

Abstract: Rotational atherectomy is the treatment of choice for calcified coronary lesions. It should not be used routinely but only in some appropriate cases, especially when the successful deployment of a stent may be uncertain. Complications are rare but serious. Several cases of “off label” use, however, have been reported in the literature without additional complications. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to describe our experience with cervico-isthmic cerclage by abdominal approach and to assess this efficacy. Patients and methods: A retrospective analysis of 13 transabdominal cerclages (eight by laparotomy and five by laparoscopy), seven cases performed before pregnancy and six cases between 12 and 14 weeks of gestation, between 2004 and 2009. We analyzed the previous obstetric accidents, the etiology of cervical incompetence and the patient outcome after cerclage. Results: Median age of the patients was 35 years [27–42 years]. Patients had an average of pregnancy 4,2 [1–7], with 3,3 previous fetal losses or preterm delivery. Eighty percent had a prior failed transvaginal cerclage. The mean operative time of laparotomic cerclage was 100 minutes and 94 minutes by laparoscopy, with a mean hospitalization time respectively of seven and 2,5 days. No operative complication was reported. Eleven women were pregnant after cervico-isthmic cerclage: nine deliveries by caesarean section at term, and two preterm births between 34 and 37 weeks of gestation. Two patients are looking for being pregnant and one of those is currently doing a procedure of IVF. Discussion and conclusion: Transabdominal cervico-isthmic cerclage is an alternative technique for the management of cervical incompetence after failed vaginal cerclage. Our data indicated that the cervico-isthmic cerclage placed laparoscopically compares favorably with the laparotomy approach in regard to operative technique and risk of complications. [Copyright &y& Elsevier]

Abstract: Objectives: To describe the safety and efficacy of single-port access for laparoscopic surgery in gynecology with conventional laparoscopic instruments. Patients and methods: In this prospective study, we report our experience with 90 patients who underwent Single Port Access (SPA) laparoscopic surgery for gynecologic pathology with the use of the SILS® Port Multiple Instrument Access Port (Covidien®, Mansfield, MA). Results: We realised 15 ovarian cystectomies, 30 salpingo-oophrectomies with 14 one side, 9 lysis of adhesions, 7 distal tubal repairs, 6 salpingectomy, 8 other procedures. The mean surgical time is 47min (25–120). One conversion to conventional laparoscopy and one in laparotomy were performed. The mean duration stay is 2 days [1–3]. Discussion and conclusion: SPA in gynecology is feasible with conventional laparoscopic instruments. SPA surgery represents the newest frontier in minimally invasive surgery. [Copyright &y& Elsevier]