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Resume Introduction Le retour le plus rapide possible a une vie normale sur le plan social et professionnel est le souhait de toute patiente qui envisage un lifting facial. L’utilisation du bistouri Harmonic (ultracision) pour cette indication a transforme dans notre pratique les suites operatoires apres liftings cervico-faciaux. Patients et methodes Depuis 2001, nous avons realise 920 liftings cervico-faciaux en utilisant de facon exclusive le bistouri Harmonic. Resultats La duree moyenne de l’intervention etait de 110 minutes pour les liftings cervico-faciaux avec SMAS et de 180 minutes pour les liftings cervico-faciaux avec SMAS + abord sous-mental et plastie du platysma. Le retour a la vie sociale etait possible dans la majorite des cas au huitieme jour. Conclusions L’utilisation du bistouri Harmonic, une fois integre son mode d’utilisation, reduit de facon evidente l’importance des ecchymoses, de l’œdeme postoperatoire et un retour beaucoup plus prompt a une vie sociale normale.

Resume La reconstruction des malformations complexes de l’oreille est l’une des techniques chirurgicales les plus longues a maitriser, car il faut a la fois une analyse precise de la malformation, du potentiel cutane, ainsi qu’un long apprentissage de la sculpture des reliefs complexes de l’oreille. Les petites anomalies peuvent etre prises en charge par tout chirurgien plasticien, mais la encore il faut bien connaitre tous les raffinements techniques de la chirurgie de l’oreille. Nous faisons ici le point sur 30 ans d’experience en reconstruction auriculaire, allant des petites anomalies a la microtie (2500 cas), en excluant les variantes esthetiques que sont les oreilles decollees.

L’orecchio, la cui architettura e tridimensionale e complessa, puo avere delle forme molto varie. Correggere un’anomalia congenita dell’orecchio esterno significa riprodurre dei rilievi assenti o deformati tenendo conto dell’anatomia normale di un orecchio. In genere, solo l’utilizzo di un sostegno cartilagineo puo permettere di riprodurre questi rilievi. A lungo considerata difficile e deludente, la ricostruzione delle orecchie malformate con tessuti autologhi permette, attualmente, di ottenere dei risultati esteticamente soddisfacenti e duraturi, quando e realizzata secondo delle regole e dei principi ben stabiliti. Noi affronteremo in questa sede la ricostruzione auricolare nel quadro delle microtie, ma anche in quello delle piccole anomalie, come in caso di criptotia, di orecchio a cornetta, di orecchio di Stahl e di agenesia del lobulo.

International audience; Adipocyte differentiation and function relies on a network of transcription factors, which is disrupted in obesity-associated low grade, chronic inflammation leading to adipose tissue dysfunction. In this context, there is a need for a thorough understanding of the transcriptional regulatory network involved in adipose tissue pathophysiology. Recent advances in the functional annotation of the genome has highlighted the role of non-coding RNAs in cellular differentiation processes in coordination with transcription factors. Using an unbiased genome-wide approach, we identified and characterized a novel long intergenic non-coding RNA (lincRNA) strongly induced during adipocyte differentiation. This lincRNA favors adipocyte differentiation and coactivates the master adipogenic regulator peroxisome proliferator-activated receptor gamma (PPARγ) through interaction with the paraspeckle component and hnRNP-like RNA binding protein 14 (RBM14/NCoAA), and was therefore called PPARγ-activator RBM14-associated lncRNA (Paral1). Paral1 expression is restricted to adipocytes and decreased in humans with increasing body mass index. A decreased expression was also observed in diet-induced or genetic mouse models of obesity and this down-regulation was mimicked in vitro by TNF treatment. In conclusion, we have identified a novel component of the adipogenic transcriptional regulatory network defining the lincRNA Paral1 as an obesity-sensitive regulator of adipocyte differentiation and function.

Rapid recovery and return to social activities are what every patient wishes when considering to undergo a face lifting procedure. In our practice, the use of the Harmonic scalpel in order to achieve this goal has greatly improved the postoperative period.We have performed 920 face lifting procedures exclusively using the Harmonic scalpel from 2001 to May 2017.A retrospective chart review was performed. Mean operative time was 110minutes for facelift involving SMAS plication only, and 180minutes for facelift involving SMAS plication with the addition of submental approach for anterior platysma plasty. Return to normal social life was achieved on the 8th postoperative day for the majority of cases.The use of the Harmonic scalpel, once properly integrated in the face lifting procedure, significantly reduces postoperative ecchymosis and oedema and allows a prompt return to normal social life.

International audience; Chicken ovalbumin upstream promoter-transcription factor II (COUP-TFII/NR2F2) is an orphan member of the nuclear receptor family of transcription factors whose activities are modulated upon binding of small molecules into an hydrophobic ligand-binding pocket (LBP). Although the LBP of COUP-TFII is filled with aromatic amino-acid side chains, alternative modes of ligand binding could potentially lead to regulation of the orphan receptor. Here, we screened a synthetic and natural compound library in a yeast one-hybrid assay and identified 4-methoxynaphthol as an inhibitor of COUP-TFII. This synthetic inhibitor was able to counteract processes either positively or negatively regulated by COUP-TFII in different mammalian cell systems. Hence, we demonstrate that the true orphan receptor COUP-TFII can be targeted by small chemicals which could be used to study the physiological functions of COUP-TFII or to counteract detrimental COUP-TFII activities in various pathological conditions.

La reconstruccion del pabellon auricular requiere un analisis preciso de los relieves destruidos y del potencial cutaneo local. Para reconstruir los relieves complejos, es preciso utilizar un soporte de cartilago autologo que, dependiendo de las lesiones, sera el fibrocartilago de la concha o el cartilago costal. La calidad de la piel que recubre los relieves reconstruidos determinara el pronostico de la reconstruccion y debe evaluarse de forma individualizada. A pesar de la gran diversidad de las lesiones observadas tras las amputaciones parciales o totales de los pabellones, se pueden proponer varios principios comunes y reglas precisas, que permiten establecer un algoritmo terapeutico.

La ricostruzione del padiglione auricolare richiede un’analisi precisa dei rilievi distrutti e del potenziale cutaneo locale. La riproduzione dei rilievi complessi impone l’utilizzo di un supporto di cartilagine autologa che, secondo le lesioni, e la fibrocartilagine della conca o la cartilagine costale. La qualita della cute che ricopre i rilievi ricostruiti condiziona la prognosi della ricostruzione e deve essere valutata caso per caso. Malgrado la grande varieta delle lesioni osservate dopo amputazioni parziali o totali dei padiglioni, possono essere proposti alcuni principi comuni e delle regole precise che permettono di stabilire un algoritmo terapeutico.

Reconstruction of complex auricular malformations is one of the longest surgical technique to master, because it requires an extremely detailed analysis of the anomaly and of the skin potential, as well as a to learn how to carve a complex 3D structure in costal cartilage. Small anomalies can be taken care of by any plastic surgeon, providing that he/she is aware of all the refinements of ear surgery. In this chapter, we analyze retrospectively 30 years of auricular reconstruction, ranging from small anomalies to microtia (2500 cases), excluding aesthetics variants such as prominent ears.

Resume Introduction Le pavillon auriculaire est une structure complexe et delicate dont il ne faut pas negliger le traitement chez un grand brule. Nous detaillerons ici les cas de figures auxquels le chirurgien peut etre confronte et presenterons un algorithme therapeutique. Patients et methodes De 1984 a 2011, nous avons opere 134 patients pour sequelles de brulures d’oreille, dont 90 cas unilateraux (67 %) et 44 cas bilateraux (32 %), soit 178 oreilles au total. Notre technique en deux temps est basee sur la sculpture du cartilage costal et de sa couverture par la peau mastoidienne, le fascia temporal superficiel (FTS) ou l’expansion indirecte. Resultats Le cartilage costal autologue est le support le plus adapte lorsque la perte de substance depasse un quart du pavillon et/ou deux plans. L’integrite de la peau mastoidienne est le facteur de meilleur pronostic pour une reconstruction auriculaire. Si elle est abimee, le FTS peut etre utilise. Si celui-ci a ete detruit, l’expansion indirecte represente le dernier recours avant la pose d’une epithese. Conclusion La reconstruction d’une ou des deux oreilles est souvent l’ultime geste chirurgical lors de la reparation des sequelles de brulures. Il est souhaitable qu’il ne soit pas realise de facon occasionnelle sans une connaissance precise des regles et principes de la reconstruction auriculaire, car il s’agit bien souvent des reconstructions les plus complexes.

Las microtia se presenta segun formas clinicas muy diversas, aisladas o integradas en un sindrome malformativo (sindrome otomandibular, sindrome de Goldenhar, sindrome de Franceschetti). En todos los casos, la reconstruccion del pabellon auricular debe realizarse a partir de los 9-10 anos de edad, utilizando cartilago costal autologo, que reproduce los relieves ausentes en un primer tiempo. A los 6 meses, se reconstruye el surco retroauricular y la proyeccion de la oreja se logra con un injerto de cartilago recubierto de fascia temporal y de un injerto de piel de espesor delgado. Una experiencia basada en 1.500 casos de reconstrucciones auriculares permite proponer una clasificacion quirurgica de los accesos cutaneos en tres tipos, que garantizan la correccion de todas las formas clinicas de microtia. En este articulo se detallan los problemas tecnicos especiales que plantean los casos de asimetria facial, de implantacion baja del pelo, de anomalia bilateral o de intervenciones previas, asi como las posibles complicaciones y su tratamiento. Las reconstrucciones auriculares realizadas con cartilago costal tienen fama de ser una cirugia dificil, que no debe suponer un impedimento para usar materiales sinteticos o una protesis. Una comprension tridimensional de la oreja y el conocimiento de las reglas de esta cirugia permiten obtener resultados satisfactorios y duraderos.

Le microtie si presentano sotto forme cliniche molto varie e sono o isolate o integrate in una sindrome malformativa (sindrome otomandibolare, sindrome di Goldenhar e sindrome di Franceschetti). In tutti i casi, la ricostruzione del padiglione auricolare e realizzata a partire dall’eta di 9–10 anni, utilizzando della cartilagine costale autologa che riproduce i rilievi mancanti al momento del primo tempo. Sei mesi piu tardi, e ricostruito il solco retroauricolare e la proiezione dell’orecchio e assicurata da un innesto di cartilagine ricoperto da una fascia temporale e da un innesto sottile. Un’esperienza che si basa su 1 500 casi di orecchie ricostruite permette di proporre una classificazione chirurgica degli accessi cutanei in tre tipi che assicurano la correzione di tutte le forme cliniche delle microtie. Sono precisati i problemi tecnici particolari incontrati in caso di asimmetria del volto, di impianto basso dell’attaccatura dei capelli, di anomalia bilaterale o di interventi precedenti, cosi come le possibili complicanze e il loro trattamento. Le ricostruzioni auricolari realizzate con la cartilagine costale hanno una reputazione di chirurgia difficile, che non deve essere utilizzata per proporre dei materiali sintetici o una protesi. Una concezione tridimensionale dell’orecchio e una conoscenza delle regole di questa chirurgia permettono di ottenere risultati soddisfacenti e duraturi.

Resume But Decrire la vessie rectale a basse pression de Ghoneim dont les auteurs ont simplifie la technique en ne faisant ni la valve colocolique, ni la colostomie. Methode Trente-six patients ont ete operes selon cette technique simplifiee. Resultats La simplification de la technique n’a pas ete source de complication. Elle a diminue le temps operatoire et a evite un acte chirurgical secondaire (fermeture de colostomie).

Resume Objectif Presenter une technique de reparation des fistules recto-uretrales apres prostatectomie utilisant une voie d’abord perineale et cœlioscopique. Observation En 2007 et 2008, deux patients (52 ans et 60 ans) ayant une fistule recto-uretrale apres prostatectomie cœlioscopique ont ete operes par une technique associant reparation perineale et interposition de l’epiploon abaisse dans le petit bassin par voie cœlioscopique. Conclusion Il s’agit d’une technique mini-invasive, assortie d’une duree d’hospitalisation courte, ayant permis dans notre experience la cicatrisation rapide de fistules organisees.

Resume Dans les dix dernieres annees, la curietherapie prostatique par implantation permanente s’est imposee comme une reelle alternative therapeutique dans le traitement des cancers localises de la prostate. La publication recente de resultats a 10-12 ans montre des resultats equivalents, pour une population selectionnee, a ceux de la chirurgie et de la radiotherapie conformationnelle, avec un faible taux de complications. Les criteres de selection ont bien ete definis par les societes savantes : tumeur classee T1 ou T2, concentration serique de PSA

The technique of reconstruction of a microtia, observed in cases of otomandibular dysplasia, does not differ in its principle from that of an isolated microtia. The technical approach depends primarily on the aspect of the auricular remnants whose forms are multiple and are in no way etiologically specific. However, when associated with other malformations of otomandibular dysplasia, the microtia presents some particularities and its correction must be integrated in the global treatment of hemifacial anomalies.

Resumen La calidad de los resultados obtenidos tras la reconstruccion del pabellon auricular ha mejorado enormemente en los ultimos 20 anos. Los avances en las tecnicas quirurgicas han permitido definir mejor las indicaciones segun el tipo de lesion. El principio comun a todas las reparaciones auriculares, cualquiera que sea la deformidad, consiste en reproducir los relieves destruidos con un soporte cartilaginoso, cuya eleccion (fibrocartilago de la concha o cartilago costal autologo) depende de la extension de la lesion, de acuerdo con una norma precisa. La calidad de la pi el que recubre los relieves auriculares reconstruidos influye en el pronostico de la reparacion y debe evaluarse caso por caso. Despues de una descripcion detallada de la tecnica quirurgica y una clasificacion de los diferentes tipos de lesion, se ilustran las diversas indicaciones con casos clinicos.

The external ear is a complex, delicate structure and treatment of burned ears should not be neglected. We will detail the different scenarios a surgeon can encounter and present a therapeutic algorithm.From 1984 to 2011, we operated 134 patients for ear deformities secondary to burns, of which 90 cases were unilateral (67%) and 44 cases bilateral (32%), accounting for 178 ear in total. Our two-stage technique is based on an autologous cartilage framework, covered by mastoid skin, superficial temporal fascia (STF) or indirect skin expansion, and later by elevation of the construct.Costal cartilage is the ideal support when loss of substance is greater than one quarter of the ear pavilion and/or two plans. Mastoid skin integrity is the best factor of prognosis when planning an ear reconstruction. If injured, the STF can be used. If the STF has been injured as well, indirect expansion represents the last option before placement of prosthesis. Free contralateral STF is rarely an option in these patients, although it should be considered.Reconstruction of one or both ears is often the last step in a rehabilitation process after burns. It is ideally performed after wound healing has been achieved, and by a team well trained in microtia treatment and post-traumatic reconstruction.

Ear reconstruction is considered to be a challenging form of surgery. In cases of microtia, surgeons must reconstruct complex missing contours, which necessitates the use of a support and skin remnants to cover this support. Although the use of synthetic material has been proposed in order to avoid harvesting and carving cartilage, the best long-term choice for reconstructing an ear is autologous rib cartilage. This procedure requires good understanding of the 3-dimensional architecture of the ear and learning the step-by-step construction of a harmonious framework (which with practice will become the most straightforward part of the procedure). Surgery, usually performed at the age of 9 or 10 years, is planned in 2 stages. In the first stage, the framework is placed under a skin pocket. Six months later, the sulcus is created using an additional cartilage graft for projection and a skin-grafted galeal fascial flap. In order to shorten the learning curve, a detailed carving process is described here, as well as a tool to enable training before surgery. Remnants of the microtic ear can have many different shapes; therefore, a comprehensive approach to skin management is proposed, providing a simple surgical classification for all types of microtia. Furthermore, some refinements of the cartilage framework and the construction of the retroauricular sulcus have improved results. Whenever possible, successful reconstruction of a microtic ear with autologous rib cartilage, as opposed to synthetic materials, is by far the best option.

Ear reconstruction is considered to be a challenging form of surgery. In cases of microtia, surgeons must reconstruct complex missing contours, which necessitates the use of a support and skin remnants to cover this support. Although the use of synthetic material has been proposed in order to avoid harvesting and carving cartilage, the best long-term choice for reconstructing an ear is autologous rib cartilage. This procedure requires good understanding of the 3-dimensional architecture of the ear and learning the step-by-step construction of a harmonious framework (which with practice will become the most straightforward part of the procedure). Surgery, usually performed at the age of 9 or 10 years, is planned in 2 stages. In the first stage, the framework is placed under a skin pocket. Six months later, the sulcus is created using an additional cartilage graft for projection and a skin-grafted galeal fascial flap. In order to shorten the learning curve, a detailed carving process is described here, as well as a tool to enable training before surgery. Remnants of the microtic ear can have many different shapes; therefore, a comprehensive approach to skin management is proposed, providing a simple surgical classification for all types of microtia. Furthermore, some refinements of the cartilage framework and the construction of the retroauricular sulcus have improved results. Whenever possible, successful reconstruction of a microtic ear with autologous rib cartilage, as opposed to synthetic materials, is by far the best option.

The aim of this article is to illustrate the aetiologies of mixed hearing loss that can benefit from a Vibrant Soundbridge (VSB) middle ear implant, the techniques performed and the first results.The authors report their experience of 13 implantations in mixed hearing loss due to otosclerosis, sequelae of chronic otitis media and congenital aural atresia. The VSB implant was implanted alone or in association with another middle ear surgical procedure, on the ossicular chain or on the round window membrane.The average auditory gain for all patients is 32 dB for pure tone thresholds, and 25 dB for speech recognition. It results from the addition of a gain on the conductive hearing loss by direct stimulation of the inner ear, to a gain on the sensorineural hearing loss by amplification.Middle ear implants are the only hearing aids affording a gain in both the conductive and sensorineural components of mixed hearing losses.

Description of the Ghoneim's low pressure rectal bladder, without colo-colic valve and colostomy.Thirty-six patients underwent this simplified technique.The simplification of the technique did not increase the complication. The operating time has been lessened. The closing colostomy was avoided.

RUF is a rare occurrence usually following radical prostatectomy. We report our short experience and outcomes with the repair of Iatrogenic Recto-urinary fistula using a combined laparoscopic and perineal approach.We retrospectively reviewed the medical records of our patients who underwent lately a combined approach using laparoscopic and perineal procedure. Two patients in our unit underwent a RUF repair associating a laparoscopic mobilization of the omentum and a perineal closure. A temporary colostomy was performed at the time of RUF diagnosis and closed few weeks after the RUF repair procedure. Procedure time was 255mn. Blood loss was short and no transfusion was required.All fistulae were closed within a short hospitalization time and an easy outcome. The delay between the diagnosis and the final closure of the colostomy was reduced to 3 months in our short experience.The procedure is safe and provides nice exposure and a thick and very well vascularized flap. Shortening the management of this complication after reduces the anxiety of the patients and his medical team.

Summary Background Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. Methods A retrospective review of the notes of all patients who presented to Clinique George Bizet (1981–2007) in Paris, for correction of complications after undergoing prominent ear surgery at another facility, was performed. Each patient's age, gender, diagnosis, number of previous operations and final outcome were noted as available. Patients were included in this study if they had undergone one or more operations for prominent ears, leading to severe destructive complications, prior to consultation with the senior author and then underwent surgical repair with either an auricular (conchal) cartilage graft or with autogenous costal cartilage. Results A total of 49 (25 female, 24 male) patients met the inclusion criteria. The mean age at presentation was 23 years (range of 10–59 years of age). The mean number of previous attempts to correct the ear deformity was 1.3 (1–12) times. Eight patients underwent reconstruction with a conchal cartilage graft and 41 with costal cartilage. Conclusions While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.

Purpose: We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer. Materials and Methods: From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. 125 -Iodine and 103 palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique. Results: Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4). Conclusions: After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.

Real-time ultrasound (US)-based dosimetry performed during (125)I loose seed implantation provides the radiation oncologist with an estimation of the dose distribution at seed insertion. However, for a number of reasons, this distribution may not reflect the real (reference) dosimetry as determined by subsequent CT, usually performed 1-2 months after implantation. The present study compared the two dosimetry data sets (US and CT) to evaluate how predictive extemporaneous US-based dosimetry can be of the real dose distribution.A total of 450 patients with prostate cancer were treated with loose (125)I seed implantation between June 1999 and October 2002 by the Institut Curie/Hospital Cochin (Paris) Group. The mean patient age was 65 years. Most patients (74%) had Stage T1c; the stage did not exceed T2b for the others. All patients had a prostate-specific antigen level of15 ng/mL and was10 ng/mL for 72%; 84% had a Gleason score ofor =6 and did not exceed 7 for the others; and 56% were treated with neoadjuvant hormonal therapy for a mean of 4.3 months. All patients were treated with loose seed implantation. Real-time US-based dosimetry was performed intraoperatively for all patients. CT-based dosimetry was performed 2 months after implantation, using the VariSeed software. The minimal dose to 90% of the outlined volume (D(90)) and percentage of volume receiving at least 100% of the prescribed dose (V(100)) were calculated with the two methods and compared for all patients.On CT-based dosimetry, the D(90) was found to beor =145 Gy (range, 115-240 Gy) in all patients except one. A large majority (86%) of patients showed a CT-based V(100) of95%, and 48% had a V(100) of98%. The mean CT-based D(90)/US-based D(90) ratio was 1.0 (range, 0.66-1.33). For 89% of the patients, the difference between the two values was20% and for 62% was10%. The mean CT-based V(100)/US-based V(100) ratio was 0.98 (range, 0-1.02), with 89% of patients showing a difference of5%.Our results indicate that the D(90) and V(100) values obtained intraoperatively with our real-time US-based dosimetry are in reasonable agreement with the subsequent values obtained with CT-based dosimetry performed 2 months after implantation. Recent innovations in our dose planning software allowed better control of the longitudinal seed position and could still improve the correlation between real-time US-based dosimetry and the subsequent CT-based dose distribution.

In the last decade, brachytherapy emerged as a particularly appealing new way ot treating localized prostate cancer. Recently published 10-12 years biochemical control results appear to be superimposable to the best percentages achieved by surgery or conformal radiotherapy, with a small percentage of complications. This applied to severely patients. Only patients with T1/T2, PSA10 ng/mL, and Gleason score7 should be proposed such a treatment. The potential benefit of exploring patients with a endorectal coil MRI is being evaluated. The number of positive biopsies is also a parameter which should probably be considered in the therapeutic choice. Moreover, a prostate volume60 g, hip mobility limitations, a urinary obstructive syndrome and previous transurethral resection lead to difficulties in technical implantation and therefore must be taken into account when discussing brachytherapy. In conclusion, for adequately selected patients, brachytherapy offers a particularly applied alternative to surgery and external radiotherapy, with satisfactory long term biochemical control rates and limited complications.

In the correction of microtia, whether it be isolated or associated to other facial anomalies, the same principles are followed: sculpture of a framework from autologous rib cartilage to reproduce the contours of an ear and coverage of the framework with the cutaneous remnants. The sculpting of the cartilaginous framework requires sufficient training which through experience becomes the most routine surgical step of the reconstruction. Regarding the cutaneous step, it is different, because the microtia may appear in multiple forms. Numerous clinical classifications have already been published. The new classification which has been proposed, enables a better understanding of the cutaneous step of microtia correction. It is a surgical classification. Three different types of skin plasties (type 1, 2 and 3) allow for the treatment of all microtia. Thus, a surgical proposal can be advocated as early as the clinical examination regarding the appropriate utilization of the cutaneous remnants.

The technique of reconstruction of a microtia, observed in cases of otomandibular dysplasia, does not differ in its principle from that of an isolated microtia. The technical approach depends primarily on the aspect of the auricular remnants whose forms are multiple and are in no way etiologically specific. However, when associated with other malformations of otomandibular dysplasia, the microtia presents some particularities and its correction must be integrated in the global treatment of hemifacial anomalies.

The authors report a case of benign pseudosarcoma of the bladder and emphasize the endoscopic features of the tumour, which were highly suggestive of malignancy, leading to the decision to perform cystectomy. The diagnosis was corrected by endoscopic resection and histology. Treatment usually consists of partial cystectomy, but can sometimes be limited to one or several endoscopic resections.

Pessimism about the results of surgical reconstruction of the pinna in cases of microtia is unjustified. Currently there are two techniques available which give excellent results if conditions are favourable: these are the techniques of Brent and of Nagata. This article describes both of these techniques, whose common principle is the use of autologous costal cartilage sculptured to give the contour of a normal ear, and the areas where they are different. The author has carried out 154 reconstructions using the Brent technique and 92 using the Nagata technique, and gives a critical analysis of the results obtained by these two methods.

By recalling the imperatives of auricular reconstruction, the author analyses the indications for tissue expansion in this area. This expansion can be performed preoperatively or intraoperatively, directly on the ear, indirectly, away from the ear. In the light of his experience, illustrated by three clinical cases, the author considers preoperative indirect expansion to be the most useful, by placing the expander underneath the scalp.

Reconstruction of an ear destroyed by burns raises several difficulties related to the presence of associated lesions. The essential element determining the indication for reconstruction is the possibility to cover a three dimensional cartilaginous graft with skin. Depending on the local condition of the skin, retroauricular skin, a temporal fascia flap or preliminary expansion may be indicated. Reconstruction should be performed when the chances of obtaining a good result are sufficient in a motivated patient. If these conditions are not satisfied, prosthesis should be proposed.

Malignant entero-vesical fistulas are uncommon. Colonic malignancy is the main cause although fistula are present in just 1%. Pneumaturia and fecaluria are pathognomonic for entero-vesico-fistula and are present in half of cases. By combining the results of cystoscopy, barium enema and urine culture, fistula can be identified in almost all the cases. Escherichia coli, Streptococcus faecalis and Proteus mirabilis are very often isolated from the urine cultures. The management of entero-vesical-fistula depends of the etiology. The treatment requires in most of the case resection of the diseased bowel with partial cystectomy and primary anastomosis. But sometimes, is necessary to perform a diverting colostomy and urinary diversion.

The authors report the various locations (ileal, appendicular, colic, rectal and through Meckel diverticulum) of the fistulas between the bladder and the digestive tract and specify the mainly inflammatory etiologies and specifically those due to the Crohn disease or those caused by tumors aggravated by irradiation and repeated surgery.

Using 9 personal surveys and 11 cases found in the literature, the authors analyse the etiologies of this iatrogenic accident, the often secondary modalities of the diagnosis and the benign nature of the fistula which usually heals spontaneously.