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We report the outcome of the ARPE trapezometacarpal prosthesis in the treatment of primary osteoarthritis of the thumb. The prosthesis based on a ball and socket system and is uncemented. This study presents the results of 37 consecutive implantations in 29 patients; 28 women, one man, eight bilateral (21 right, 16 left). The mean age at operation was 67 years at a mean of 36 months follow-up (maximum 7 years). Four patients were excluded (1 died, 3 lost to follow up). Preoperative radiological grading according to Comtet was 1 or 2. Patients all had low functional demand. Most of the patients were satisfied and pain free. Mobility was increased, including dorsal extension of the first metacarpal. Radiographic analysis and measurement of the scaphometacarpal index demonstrated a postoperative increased length of the thumb column, with a slight decrease at follow up. This phenomenon is due to sinkage of the prothesis into the cancellous bone. Mechanical complications occurred in four patients within the first four years. Removal of the prosthesis, trapeziectomy and tendon strip plasty were performed in three cases with good final results. This prothesis is a good surgical treatment of primary, isolated TM osteoarthritis in patients with minimal osteoporosis and low functional demands.

Surgery has long been considered standard treatment in early stage non–small cell lung cancer. Preoperative chemotherapy is a real challenge in the treatment of these stages. Some conclusions can be drawn from the first phase II studies in stage IIIA tumors. Response rates were higher than those observed in stage IV tumors, reaching approximately 70%. Although toxicity seemed acceptable, increased morbidity and mortality have to be taken into account for the choice of preoperative regimens. Two randomized studies that included only a few patients were conducted in stage IIIA disease and showed highly positive survival results. The French randomized study argued in favor of preoperative chemotherapy with an absolute difference in survival rates that remains constant beyond the third year. New studies are ongoing to evaluate the role of the gemcitabine/cisplatin combination. Several phase II studies of this regimen in the preoperative setting or in combination with radiotherapy have been presented at the most recent meetings of the American Society of Clinical Oncology. These studies confirmed both its efficacy and good tolerability. In several ongoing randomized studies, this combination has been chosen to test the concept of preoperative chemotherapy. One such study, which compares two different strategies of preoperative chemotherapy, is by the Intergroupe Francophone de Cancerologie Thoracique. Semin Oncol 29 (suppl 9):55-60. Copyright 2002, Elsevier Science (USA). All rights reserved.

Summary A 49 year old man was medically treated, first in 1986 and then in 1988, for atypical primary pulmonary infection caused by Mycobacterium malmoense. Since no clinical or bacteriological improvement of both smear and culture was observed, upper right bilobectomy was performed in december 1988. Oral treatment with rifabutin, clofazimine, ethambutol and isoniazid was clinically and bacteriologically successful in May 1989. In 1990, Aspergillus flavus infection developed in a sequeleae cavity located in the posterior segment of the upper left lobe. To our knowledge the Mycobacterium malmoense-Aspergillus flavus association has not yet been described.

The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French cancer centres and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone.Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French cancer centres.The main recommendations for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone are: 1) The curative external irradiation with a continual course is an alternative to surgery only in the case of medically inoperable tumors or because the patient refuses surgery; 2) The external irradiation of the primary tumor only without the mediastinum could be proposed in peripheral stage IA. In proximal stage IA and IB, external irradiation should be carried out only as part of prospective randomised controlled trials comparing a localised irradiation of the primary tumor with a large irradiation of the mediastinum and the primary tumor. The treated volume must include the macroscopic tumoral volume with or without the microscopic tumoral volume and with a security margin from 1.5 to 2 cm; 3) There is a benefit to delivering a total dose in the primary tumor higher than 60 Gy in so far as the proposed irradiation, taking into account the respiratory function, does not increase the likelihood of severe adverse events due to radiation; and 4) The change in fractionation, the radiochemotherapy combination, the endobronchial brachytherapy with high dose rate alone or with external irradiation could be proposed only as part of prospective controlled trials for tumors classified as stage IB or II.

Summary Background Although the average age of lung cancer patients is increasing, many elderly patients remain undertreated, mainly because of the fear of higher treatment toxicity in this category of patients. We conducted a study to evaluate the efficacy and tolerability of a combination therapy with carboplatin (C) and etoposide phosphate (EP) in elderly patients with Small-Cell Lung Cancer (SCLC). Patients and methods Previously untreated patients older than 70 years with stage IIIB/IV SCLC received a combination of EP (100 mg/m2 D1, D2, D3) and C (Dl, dose calculated according to the Calvert formula). Response rate, survival and toxicity were assessed. Results Thirty-eight patients (mean age 76 years, range 70–88 years) received a total of 162 cycles. Eighteen patients (47%) received the six scheduled cycles. Thirty patients were evaluable for efficacy (2 CR and 20 PR). The median survival was 237 days and the one-year probability of survival was 26%. The most common adverse effect was transient grade 3 or 4 neutropenia, observed during 57% of evaluable cycles, while five episodes of febrile neutropenia also occurred, with one fatal (bactaeriemia). It is noteworthy that no renal or liver toxicity was observed, and no mucitis was noted. Unfortunately, a relatively high proportion of patients died shortly after the start of the study. Although most deaths seemed unrelated to the treatment, the possibility of its exacerbatory effect on comorbidities, especially cardiovascular, cannot be excluded. Conclusion The two-drug regimen of carboplatin and etoposide phosphate is feasible in most elderly patients with an acceptable toxicity, and the overall results suggest that patients even older than 70 years may benefit from full treatment. Therefore, consideration should be given to offering active treatment to most patients with SCLC, regardless of age but with special attention paid to comorbidities.

We studied a cohort of 120 patients with inoperable non-small-cell lung cancer treated with vinorelbin at the dose of 25-30 mg/m2/week in a single drug chemotherapy regimen. Surgery was contraindicated due to staging or to concomitant morbidity. Twenty patients survived 18 months or more. One survivor responded exceptionally, surviving 120 months. The mean dose intensity of Vinorelbine in long-term survivors was 21 mg/m2/week. Objective response was found at multivariate analysis to be a prognostic factor for survival beyond 18 months. Weight loss (5 kg) was an unfavorable prognostic factor in patients with metastases.

There is no consensus as the optimal duration for treatment in patients with small-cell lung cancer. In routine practice, 6 cycles of chemotherapy are usually delivered, but the rate of recurrence after achieving objective response has incited interest in several trials aimed at evaluating the effect of prolonged "maintenance" chemotherapy. Such prolonged regimens may use the same drugs as used in the induction protocol or call upon new drugs. No conclusion can be drawn from the 14 randomized studies conducted to date because of differences in the randomized populations as well as the nature of the treatments tested. Among 9 trials using a maintenance regimen with the same drugs as the induction protocol, there has been no significant difference in long-term survival. One study even found a lower 2-year survival with maintenance therapy. Among 5 trials where the maintenance protocol used drugs different from the induction protocol, survival rate favored maintenance chemotherapy in only 1. Most authors have observed a significant deterioration in quality of life in patients given maintenance chemotherapy, in addition to a number of deaths due to drug toxicity. Patient recruitment had to be interrupted in one study. The percentage of patients who received the entire maintenance protocol was also very low in many trials (20%). There may exit a theoretical advantage to giving maintenance chemotherapy, but does it counterbalance the risk of late complications? An increased risk of a second cancer has been demonstrated in patients given more than 6 cycles in the National Registry of long-term survival. Given the current state of our knowledge, it would not appear reasonable to propose maintenance chemotherapy for patients with small-cell lung cancer outside controlled clinical trial protocols.

The aim of this study was to analyze SCLC patients beyond 30 months, particularly their outcome, their way of life, and factors which could influence relapses, second-primary cancers and death.Between January 1986 and May 1995, 263 SCLC patients who survived longer than 30 months were included from 52 French institutions. The analysis was performed on the 155 cases confirmed by a pathologic review.Physical, mental and psychological states were considered as normal at 30 months in respectively 70.3%, 87.7% and 67.7% of patients, not influenced by prophylactic cranial irradiation, number of chemotherapy cycles, CCNU or cisplatin. Therapeutic sequelae were neurological impairment (13%), pulmonary fibrosis (18%) and cardiac disorders (11%) at 30 months. Return to work was possible for 40% of patients in the first two years following diagnosis. Among 43 relapsing patients, 33 benefited from a second-line treatment. Their median survival was 12 months since retreatment, and seven patients have survived again longer than 30 months. Age60 at the time of diagnosis was found as an independent factor increasing the risk of relapse beyond 30 months (OR = 2.46, IC 95% (1.16-5.26), P = 0.01). The risk of relapse became less than 10% beyond five years. Twenty patients (13%) developed a second primary cancer in a mean time of 58.6 months. The risk of second primary cancer was increased by a number of chemotherapy cycles6 (OR = 3.25, IC 95% (1.08-9.8) P = 0.02) and by an age60 (OR = 2.92, IC 95% (1.07-7.97), P = 0.03). Five- and 10-year survival rates were respectively 68% and 44%. In these patients having reached a 30-month survival, three independent factors were predictive of a survival longer than five years: ageor = 60 at the time of diagnosis (OR = 2.85, IC 95% (1.23-6.6), P = 0.01), chest radiotherapy (OR = 3.1, IC 95% (1.28-7.69), P = 0.006) and absence of relapse (OR = 4.5, IC 95% (1.75-12.5), P = 0.002). This study suggests that: 1) therapeutic sequelae are rather mild, allowing return to work in 40% of patients; 2) relapsing 30-month survivors can benefit from second-line treatment; 3) SCLC cure can be achieved with a 10-year follow-up.

Effectiveness of chemotherapy has been demonstrated in stage IV non small cell lung cancer as well as in stage IIIb disease when combined with radiotherapy. A significant improvement of both survival and quality of life was shown and is thought to be associated with higher efficiency. Therefore, treatment of relapses is now a question of practical interest. Ninety-seven non small cell lung cancer patients who were delivered a second line chemotherapy following primary chemotherapy alone were reviewed. Sixty-five patients were administered a 2 drug cisplatin-based regimen (with etoposide, bleomycin or vinorelbine). Twenty eight patients received no cisplatin but the cyclophosphamide, epirubicin combination or any 2-drug regimen assembled from the following agents: etoposide, mitomycin, ifosfamide. The last 4 patients were given single-agent vinorelbine. Fifteen objective responses (15.2%) (95% CI: 9-24%) were observed. The median response duration was 27 weeks. Response rates were 18.4% (95% CI 9-28%) and 9.3% (95% CI: 0-19%) in cisplatin-based combinations and in other regimens, respectively. No difference in response rates was observed between primary responsive and non responsive patients but response rates were influenced by the choice of the first line combination chemotherapy.

In both Phase III trials of vinorelbine-cisplatin (VP) versus single-agent vinorelbine, the received vinorelbine dose intensities were 18.8 and 21.1 mg/m 2 per week in the VP arms. Vinorelbine was administered at the weekly dose of 30 mg/m 2 . A new structure of the vinorelbine-cisplatin regimen delivering alternating doses of vinorelbine (35 mg/m 2 on weeks 1, 3, 5 and 17.5 mg/m 2 on weeks 2 and 4) was reported to increase the vinorelbine dose intensity in patients with non-small cell lung cancer (NSCLC). To further analyze the ability of such an alternating vinorelbine schedule to enhance vinorelbine delivery, a Phase II study of VP was conducted in NSCLC patients using the previously published alternating doses of vinorelbine for 6 cycles. Cisplatin was administered on weeks 1, 5 and every 6 weeks thereafter, at a dose of 75 mg/m 2 in the first 14 patients and at a dose of 100 mg/m 2 in the 18 remaining patients. The intended vinorelbine dose intensity was 26.25 mg/m 2 per week. The median delivered dose intensities of vinorelbine calculated during the first 8-week period were: all patients, 17.9 mg/m 2 per week; patients treated with cisplatin 75 mg/m 2 , 18.1 mg/m 2 per week; patients receiving cisplatin 100 mg/m 2 , 17.9 mg/m 2 per week; naive patients 18.2 mg/m 2 per week and previously treated patients, 13.2 mg/m 2 per week. Reductions and delays in the vinorelbine treatment mostly occurred on weeks 3 and 7, which are times of high-dose treatments (35 mg/m 2 ) according to the protocol. The partial response rate was 34% (95% C.I. = 26–42%). Median survival was 21 weeks. The main toxicities were febrile neutropenia (nine patients, including two septic deaths) and constipation Grades 3 and 4 (five patients). Conclusion : The use of alternating doses of vinorelbine within the VP regimen did not lead to higher vinorelbine delivered dose intensities than those reported with a standard weekly 30 mg/m 2 administration.

The purpose of this trial is to assess the possible benefit of neoadjuvant chemotherapy before surgery in patients with operable non-small cell lung cancer. Patients with operable stages I (except T 1N0), II, or IIIA disease are eligible for this ongoing trial. Patients are randomized into two arms. Surgery is performed first in group I; patients found to have T3 tumors or N2 lymph nodes are given postoperative radiotherapy. Group 2 patients start with two cycles of chemotherapy; following surgery, two more cycles are administered in responder patients and, as in group I, patients with T3 tumors or N2 lymph nodes are given radiotherapy. Chemotherapy is the MIP protocol: mitomycin 6 mg/m2 day I, ifosfamide 1.5 g/m2 days 1 to 3, cisplatin 30 mg/m2 days I to 3, and mesna 1,200 mg/m2 days 1 to 3. One hundred fifty patients were enrolled between June 1991 and September 1993. By the time this report was prepared, 117 patients had completed all assigned treatment, 63 in group I and 54 in group 2. There were two ineligible patients, one in each group. Forty-nine patients underwent thoracotomy in the chemotherapy-surgery group and 62 in the surgery-only group. There was only one progression after two cycles of chemotherapy. Rates of exploratory and incomplete surgery were 17% in group I and 12% in group 2. The trial is ongoing.

The long-term survivors of SCLC are described in 3 different types of study: analysis of prognostic factors of phase II and III chemotherapy trials (3,4,5,6,7,17,18), epidemiological studies (8) and medical registries of LTS (9,10). A small number of patients with small cell lung cancer achieve long-term survival. Most of these patients have a disease limited to the chest at the time of diagnosis. The major concerns of these LTSs are: the relapse of the SCLC, the occurrence of a second primary tumour and the occurrence of a disease related to tobacco consumption. About 20% of the LTSs die of non-cancer related causes and this exceeds the age adjusted mortality. There is a high risk of relapse in the first 4 years after the diagnosis; this risk decreases later, but relapses may be seen until 7 years. Nearly 8% of LTSs developed a SPTs are alive at 8 years; this indicates that cure is possible in SCLC, however, these patients account for less than 3% of the overall population.

Adjuvant treatments of non-small cell lung cancer (radiotherapy and chemotherapy) before or after surgery, have been tested in numerous trials, more particularly as regards postoperative chemotherapy. For a long time the results were disappointing, and in randomized studies none of the therapeutic regimens prescribed could improve the patient’s survival. New hopes of advances in this matter were raised by Goldie and Coldman [1] whose mathematical concept recommended a systemic treatment applied as early as possible in cases with localized tumour. The advent of Platinum [2], the results obtained in metastatic tumours by some associations with Platinum and those obtained in localized tumours by chemotherapy-radiotherapy [3] have been promising. Many phase II studies have shown that surgery was feasible after 2 or 3 cycles of chemotherapy [4, 8] even thought 1 of them [9] had observed a high rate of progression after chemotherapy which prevented surgery.

Association of two tunnel syndromes secondary to tophaceous gout is uncommon. This article presents a case of ulnar and carpal tunnel compression. It concerns a 71 year old man with gout and treated for that condition. He presented with paraesthesiae in the fingers and loss of muscular strength in right hand. Physical examination discovered two masses, one in the epitrochlear groove, the other in the olecranon bursa; a severe ulnar palsy and a carpal tunnel syndrome. Neurolysis of both ulnar and median nerves was performed. After 2 years follow-up, paraesthesiae disappeared but atrophy of ulnar intrinsic muscles remained unchanged. The literature is reviewed. Carpal tunnel syndrome is well known in gout (28 reported cases), and is secondary to gouty tenosynovitis. Ulnar tunnel syndrome has been described once by Akizuki in 1984. The combination of the two conditions has not been previously been reported. In our case, median nerve compression was secondary to gouty synovitis but also to a bulky tophus from the floor of the carpal tunnel.

The survival of patients with non-small-cell lung cancer (NSCLS) is closely related to surgery, but the tumour is resectable in only 25% of them. With the exception of T1 N0, where the 5-year survival rate exceeds 60%, the 2-year survival does not rise above 50%. New data are raising hopes of better results, and it appears that the so-called "neoadjuvant" treatments might increase the curability of resectable tumours. Recent randomized trials have shown that it could be of interest to combine chemotherapy and radiotherapy in unresectable localized tumours. On the other hand, therapeutic combinations containing cisplatin constitute a step forward in the treatment of metastatic cancers, with a high response rate (28 to 56%) prolonging the patients' survival. Finally, the advances achieved in treatments aimed at combating the undesirable effects of chemotherapy, notably nausea and vomiting, will make it more acceptable and therefore provide a better quality of life. Several randomized trials are in progress and will perhaps facilitate the setting up of new decision making trees for the treatment of NSCLC.

Nocardia farcinica, isolated by Nocard in 1888, has recently been redefined as a separate species to asteroides and has been recognised as human pathogen since 1975. Following airborne contamination, lung infection is most usual with frequent dissemination especially to central nervous system. Usually drug resistance makes treatment difficult. The authors describe the first case of Nocardia farcinica disseminated infection in France with lung primarily affection, empyema and encephalitis.

Adjuvant treatments of non-small cell lung cancers consist of radiotherapy and chemotherapy administered jointly or separately before or after surgery. These treatments have been tested in numerous trials, notably as regards postoperative chemotherapy. For a long time the results were disappointing, and in a randomized study none of the therapeutic regimens prescribed could improve the patients' survival. New hopes of advances in this matter were raised by Goldie and Coldman whose mathematical concept recommended a systemic treatment applied as early as possible in cases with localized tumour. The advent of platinum, the results obtained in metastatic tumours by including this agent in a variety of combinations, and those obtained in localized tumours by chemotherapy and radiotherapy combined have been the second promising element. Multicentre randomized trials have been set up after the encouraging results of a feasibility study on preoperative chemotherapy.

Objectifs Evaluer l’efficacite du stenting de la veine cave superieure dans le syndrome cave superieur d’origine maligne et identifier les facteurs de risque de recidive. Materiels et methodes Entre juin 2002 et mars 2008, 33 patients presentant un syndrome cave superieur d’origine maligne ont ete traites. Resultats Les succes technique et clinique ont ete constates chez 32 et 30 patients. Quatorze patients (48 %) ont presente une recidive, le plus souvent d’origine thrombotique. Cinq patients ont beneficie d’un traitement endovasculaire de la recidive, avec un taux de permeabilite secondaire de 100 %. Au moment du deces, le syndrome cave superieur etait absent chez 54 % des patients. La thrombose intrastent est une cause frequente de recidive du syndrome cave superieur apres stenting. Dans la pathologie maligne, existent d’autres facteurs thrombogenes : voie veineuse centrale, chimiotherapie et agents procoagulants liberes par les cellules tumorales. Conclusion Si le syndrome cave superieur d’origine maligne est efficacement traite par stenting, les recidives sont frequentes, le plus souvent par thrombose. Il est primordial de maintenir une anticoagulation efficace, par heparine en cas de progression tumorale, par antivitamine K en cas de remission.

The advent of fibroscopy, between 1865 and 1970, has made it possible to extend endoscopic exploration to high risk subjects, irrespective of their radiological image. We studied the initial radiological images observed on the standard film of 250 consecutive patients and compared these images with those observed and published by Emerson, Bariety and the Mayo Clinic 1970. The frequency of hilar mass (38%), peripheral tumours more than 4 cm in diameter (16%) and such pulmonary alterations as atelectasis or non-specific pneumonia (23.6%) has remained unchanged during the last decades. Similarly, the frequency of lung carcinomas discovered before they produced a radiological image is still low (2.8%).

The aortic valve area was serially evaluated in 45 patients, mean age 78 years, suffering from severe aortic stenosis who underwent percutaneous aortic valvuloplasty. The aortic valve area was calculated from haemodynamic data prior to and immediately after the procedure using the mean gradient. Serial determinations of the aortic valve area were also obtained 1 day before, 1 day after and 2 months after valvuloplasty from the thermodilution cardiac output and Doppler echocardiography mean left ventricle-to-aorta gradient. The mean gradient significantly decreased from 75 +/- 24 to 42 +/- 16 mmHg (P less than 0.01) when measured from haemodynamic data and from 63 +/- 20 to 41 +/- 13 mmHg (P less than 0.01) when estimated from Doppler-derived data. It rose to 48 +/- 15 mmHg at 2 months (NS). The aortic valve area increased significantly from 0.48 +/- 0.13 to 0.67 +/- 0.29 cm2 (P less than 0.01) when calculated from haemodynamic data, and from 0.53 +/- 0.18 to 0.74 +/- 0.23 cm2 (P less than 0.01) when estimated from Doppler-derived data. It declined to 0.69 +/- 0.27 cm2 at 2 months (NS). Aortic valve area values determined from haemodynamic data and from Doppler-derived data correlated well before valvuloplasty (r = 0.80, P less than 0.01) but poorly afterwards (r = 0.57, P less than 0.01). The aortic valve area was not influenced by valvuloplasty in eight patients. At 2 months, restenosis was apparent in eight patients out of 32 that were re-evaluated. Three patients died within 5 days of the procedure. After an average 12 months' follow-up, eight more patients died. Symptoms were not influenced or recurred in 17 patients, while 17 others remained improved by at least one NYHA functional class. Seven patients were operated on, and there was one operative death. The calculated aortic valve area was significantly greater at the end of the procedure in the patients with persistent improvement compared with those with a poor result (0.83 +/- 0.29 cm2 vs 0.65 +/- 0.14 cm2, P less than 0.05). In conclusion, in this study one third of the patients submitted to percutaneous aortic valvuloplasty had no objective improvement in calculated valve area or early restenosis after 2 months. Functional improvement was observed in one third of the patients. Immediate re-estimation of the aortic valve area from haemodynamic data at the end of the procedure may not reflect the actual effect of valvuloplasty on the aortic orifice.

Objectifs Les metastases osseuses echappent habituellement aux antalgiques majeurs. La radiofrequence notamment avec une approche bi ou multipolaire (Generateur Celon) permet une ablation tumorale bien circonscrite. En sterilisant la lesion la RF peut eviter le risque potentiel, lors de l’injection de ciment, de dissemination locale par refoulement de cellules malignes en proximite, ou a distance par voie hematogene. Resume Les gestes sont realises sous guidage TDM. Apres anesthesie sous-cutanee, une premiere aiguille de 22 G est poussee jusqu’au centre de la tumeur : elle assure l’anesthesie sur le trajet et permet, par technique de tuteur, de guider aisement la mise en place du trocart de cimentoplastie. Celui-ci sert en premier lieu pour inserer en abord coaxial l’aiguille RF et secondairement d’injecter le ciment acrylique. Lorsque la lesion est situee en proximite d’une structure nerveuse la mise en place d’un thermocouple permet de controler la RF et la cimentation. Quarante-cinq patients adultes avec metastases osseuses de localisations diverses (acromion, clavicule, humerus, femur, tibia, bassin, vertebres) ont beneficie d’une radiofrequence bipolaire. Dans 27 cas, la RF a ete associee a une cimentoplastie. Aucun incident significatif n’est survenu. Quarante-trois patients ont eu une reduction significative (50 % EVA) et durable de leur douleur (1 a Conclusion Sous controle TDM, la RF bipolaire des tumeurs osseuses est efficace et dans les os porteurs, le geste peut etre complete par une cimentoplastie. Dans des localisations uniques ce traitement peut etre potentiellement curateur.

Objectifs Evaluer l’association d’une ablation par radiofrequence et une cimentoplastie dans le traitement de metastases osseuses douloureuses rebelles aux therapeutiques habituelles (chimiotherapie, radiotherapie et antalgiques majeurs). La cimentoplastie est un traitement efficace et accepte dans ce domaine. Lors de l’injection de ciment, il y a un risque potentiel de dissemination soit localement par refoulement de cellules malignes en proximite ou a distance par voie hematogene. La radiofrequence notamment avec une approche bi ou multipolaire (Generateur Celon) permet une ablation tumorale bien circonscrite. Materiels et methodes Les gestes sont realises sous guidage TDM. Apres anesthesie sous-cutanee, une premiere aiguille de 22 G est poussee jusqu’au centre de la tumeur : elle assure l’anesthesie sur le trajet et permet, par technique de tuteur, de guider aisement la mise en place du trocart de cimentoplastie. Celui-ci sert en premier lieu pour inserer en abord coaxial l’aiguille RF et proceder a l’ablation, puis dans la foulee injecter le ciment acrylique. Resultats Nous avons applique cette methode pour traiter des localisations metastatiques osseuses accessibles par voie percutanee de localisations diverses (acromion, clavicule, humerus, femur, tibia, bassin, vertebres). Aucun incident n’est survenu. Les patients ont tous eu une reduction significative (EVA) et durable de leur douleur (2 a Conclusion Sous controle TDM, la RF bipolaire des tumeurs osseuses est realisable et dans les os porteurs le geste peut-etre complete par une cimentoplastie. Cette combinasion apparait comme un complement efficace du traitement des douleurs osseuses rebelles.

The authors have transferred the posterior part of the deltoid muscle to the triceps in 21 tetraplegics. A modification of Moberg's technique has been employed utilising a strip of fascia lata reinforced by Dacron sutures to allow rehabilitation after only 3 weeks. Despite limited active extension of the elbow and diminished power, results were considered to be satisfactory by the patients. They benefited from a greater range of movement of the hand, an improved possibility of bearing weight, improvement in the use of wheelchairs and better ability to express their bladder.