Biomedical subjects
Publications and source records attributed to J Baudet.
Two cases of a human vascularized allotransplant of a complete digital flexion system are reported with detailed descriptions of the dissection technique and postoperative treatment. Satisfactory functional results open new prospects for this type of transplantation surgery.
Over the past 18 years we have operated on 50 patients who had sustained distal amputation of fingers. Their average age was 30 years (range 2-72 years). Replantation of radial digits on the right hand was most common and the thumb was involved in nearly half the cases in our series. Out of the 50 cases we were able to repair both arteries in 35 patients and only one artery in the other 15. Regarding veins, two were anastomosed in 12, only one in 23 and none in 15 because of the severity of the contusion or the very distal site of replantation. Although early arterial thrombosis usually leaves no solution other than reoperation, venous complications can be relieved by ancillary methods such as leeches which we first used in 1976. We encountered a venous problem in 16 (32%) out of the 50 cases. In three cases a venous anastomosis had been performed, but in 13 others it proved impossible. If congestion was mild, paraungeal or pulpar incision provided some relief because of repeated topical application of heparin and systemic heparinization. If congestion was severe, leeches were used on average for 6 days at a frequency of four to six leeches a day. All cases where leeches were used could be salvaged. One can assess through this sequence that the use of leeches in distal digital replantation has improved the survival rate by 26%.
The department's experience of mature extracephalic vascular malformations shows that, regardless of the site and the type of the lesion, only surgical excision is able to ensure a good result for vascular malformations of the limbs. The results were almost always excellent and only the diffuse forms benefitted from preoperative sclerosant injections. Palliative treatments such as elastic compression still have a place in these indications. Arterial embolisations are only of limited value, particularly when they are selective, as a complement to surgery (risk of necrosis in peripheral lesions). All sites may be observed, but the authors particularly emphasise perineoscrotal lymphangiomatous lesions. Recurrences do occur, but are rare when the lesion is widely resected and a good quality reconstruction is performed.
The authors present a new type of the classical medial plantar flap which derives its main blood supply from the medial plantar artery, a terminal branch of the posterior tibial artery. Our approach concerning flap dissection has not been modified, but the vascular supply of the flap has been shifted and a reverse blood flow coming from the lateral plantar artery is created after dividing the posterior tibial artery just proximal to its distal bifurcation. The reverse flow medial plantar artery island flap survival is ensured by rich anastomoses that usually occur between the dorsalis pedis and lateral plantar arteries. However, the venous return is also ensured by a reverse flow as in the case of lateral plantar artery. In addition, this flap presents a wide arc of rotation that is suitable for a variety of local defects, allowing cover of the foot. This new technique mainly provides a perfect indication for cover of distal weight bearing area defects of the foot when the distally based plantar flap is not possible for anatomical aberrations and/or in the presence of an unreliable blood supply of the flap itself. Moreover, it deserves a general description of a new type of flap pedicle design that we denote by the term "reverse flow Y-V extended flap pedicle". We intend to provide the readers with more details concerning clinical applications of this new surgical procedure.
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Blood transfusion and intravenous drug use are the two main modes of transmission of the hepatitis C virus (HCV). Sexual intercourse seems to play a less significant part in transmission of the HCV and data are still lacking on vertical mother-to-offspring transmission. HCV seroprevalence was determined in 1,084 pregnant foreign residents of France living in a single city (Limoges). Antibodies to the HCV were detected in sera using both the first and second generation Abbott ELISA kits. Sera yielding reproducible positive results with either kit were retested with a blocking test (HCV EIA Neutralization, Abbott) and a second generation RIBA (Ortho) for confirmation. For screening, use of tests detecting both nonstructural and structural antibodies improved results noticeably (5 of 16 sera). Use of confirmation tests was found to be indispensable. Overall seroprevalence was 1.47%. However, results varied across geographic regions or origin, ranging from 0% for Europe, 1.9% for North Africa and 1.78% for South-East Asia, to 4.76% for black Africa. These findings demonstrated the potential for mother-to-offspring transmission among women from high prevalence areas. A prospective study in African an Asian women is being considered to evaluate ineffectiveness and transmission using serial serologic tests and viral genome detection by polymerase chain reaction studies (PCR).
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The authors report their use of a previously undescribed skin flap situated in the submental region and vascularised by the submental artery derived from the facial artery. It is possible to raise flaps as large as 11 cm X 6 cm with an identical colour to that of the face. The pedicle flap can reach any part of the homolateral oral cavity or the lower 2/3 of the homolateral side of the face (with the exception of the nasal region). The free flap, using a good calibre pedicle (including facial arteries and veins, may be as long as 7 cm and appears to be extremely reliable. It is also possible to use a distal or composite pedicle taking a segment of the internal basilar margin. The donor site scar dissimulated under the mandible is perfectly acceptable.
The risk of perinatal B virus transmission is well known, but is estimated in France on results obtained from blood donors or from urban populations. In the present study, the screening of HBs Ag was carried out during five years (1984-1988), within a sample population of pregnant women (french women: 8,364, immigrant women: 1,206) seen in the university hospital of Limoges. Positive sera for HBs Ag were also tested for the other markers of B virus including specific DNA, and markers of the delta virus. The total seroprevalence of HBs Ag among these women was 0.54%, and was significantly higher in the immigrant women group (2.57%) when compared to that of french women (0.25%). During the same period (1984-1988), the seroprevalence among females blood donor was 0.03%. Among the HBs Ag chronic carrier pregnant women (n = 52), 27% were HBe Ag positive and four of them (31%) had viral DNA in their serum. Viral DNA was found in three women who were HBe Ag negative. Thirteen per cent of the HBs Ag positive pregnant women were infected by the delta virus.
The authors present the anatomy and clinical applications of a new donor site for free or pedicled transfers. It is localised on the posterior aspect of the forearm, over the distal radius, and based on a posterior branch of the anterior interosseous artery. It can be used as a free skin flap, osteoperiosteal or osteocutaneous transfer. Reinnervation is possible. Indications in hand surgery are numerous. Five consecutive cases have been operated upon successfully.
The latissimus dorsi myo-cutaneous flap has been used for restoration of elbow flexion in 8 cases. The indication for this transposition were brachial plexus injuries, significant trauma to the upper limb and restoration of arm contour. The surgical technique involved unipolar muscular transposition (4 cases) with tendon plication (one case) and bipolar transposition (three cases). The evaluation of results is based on the force and degree of elbow flexion, active pronation and supination, as cortical integration. We consider that we have obtained good results in 5 cases and moderate results in three. We think that the latissimus dorsi pedicle transfer for restoring elbow flexion, is an excellent procedure which can give a good functional result with minimal donor site sequelae.
The authors report a case of surgical treatment of aortic stenosis in a pregnant woman (first pregnancy after four years treatment of sterility). The aortic valve replacement was performed at 16 weeks of amenorrhea. The valve was replaced by an Ionescu-Shiley bioprosthesis. Delivery was performed by caesarean section after 39 weeks of amenorrhea. There was no complication either for the mother or the child. Review of the literature allows analysis of the influence of aortic stenosis on pregnancy, and of the pregnancy on the tolerance of aortic stenosis. Some aspects of cardiopulmonary bypass for valve replacement in pregnant women are also analysed.
Eighty-two patients with laparoscopically confirmed salpingitis were randomly divided into two groups in a multicentre and prospective trial. Single drug therapy with the amoxicillin-clavulanic acid combination was used in 42 patients (group A). The other 40 patients were given a combination of penicillin, aminoside and metronidazole (group B). For each case a secondary prescription for a tetracycline was discussed. Clinical results were comparable in both groups: sooner (at the end of the hospitalization period) in group A: 10 cured, 30 improved and 2 failures against 9 cured, 30 improved in group B. Later (evaluation after 5 to 8 weeks) a relapse was noted in five patients in group A and included one case of angioedema in group B. It is concluded that amoxicillin-clavulanic acid combination is a satisfactory alternative to the penicillin-aminoside-metronidazole combination, especially as it is simpler to use.
We studied the diffusion of roxithromycin in the cervix mucus of fifteen healthy normal women, aged 24 to 44 (median 37). They were consulting physician to have an IUD. After this intervention (between the 4 to 7 days of menstrual cycle) they received an antibiotic treatment with the standard dose of roxithromycin: 150 mg bd for a week. At the end of this treatment the cervix mucus was taken 1 to 12 hours after the last antibiotic dose. We dose the roxithromycin by a microbial assay (Bacillus subtilis ATCC 6633, antibiotic medium 1, pH 8) and the acid alpha-1-glycoprotein by an immunodiffusion assay. All women had drug measurable with levels from 0.45 to 2.07 mg/l (median: 0.80 mg/l). The acid alpha-1-glycoprotein levels were quite constant (median: 0.19 mg/l). The antibiotic concentrations observed are above the MIC of the major genital pathogens, mainly C. trachomatis, G. vaginalis, H. ducreyi and U. urealyticum, but lower than the MIC ov N. gonorrhoeae and M. hominis.
Barley grains (9 samples from 7 cultivars) with nitrogen contents (N) ranging from 1.45 to 4.01% of dry matter were analysed for their amino acid (AA) composition with high accuracy from six different hydrolysates per sample. AA levels in grain increased as linear functions of N with correlation coefficients close to unity. A comparison with literature data confirmed that the AA composition of any grain sample of normal barley can be predicted from its N for all phenotypes and genotypes. AAs in grain protein changed as hyperbolic functions of N which increased for Phe, Pro and Glx but more or less strongly decreased for the other AAs. By plotting AA scores against N, barley proteins were shown to be always richer than wheat and rye in Val and Phe + Tyr; sometimes richer than both other species for N less than 2 (Lys); 2.2 (Leu and Ile); 3.4 (Thr); sometimes intermediate to wheat and rye above the latter N values. They were also intermediate in sulphur AAs for N less than 1.9 and drastically poorer for N greater than 1.9. However, they were richer than both other species in Trp for N greater than 1.6. The hyperbolic variations of non-protein nitrogen and nitrogen-to-protein conversion factors were determined as a function of N and also compared with those of wheat and rye.
The lateral arm flap is located on the lower lateral portion of the arm. The blood supply is via the profunda brachii artery. The flap is based on the lateral intermuscular septum of the arm, the septum being always taken with the flap; the flap can be composite and include the anterior skin of the arm or a segment of humerus, or the nerve of passage, which can be used as a vascularized nerve graft. The lateral arm flap has an important relation with three nerves: the radial nerve, which should always be preserved, the posterior cutaneous nerve of the arm, which can give a sensory innervation for the flap, and the posterior cutaneous nerve of the forearm, which can be used as a vascularized nerve graft. The authors recount the anatomic variations of the artery of the flap and describe the variations of the posterior cutaneous nerve of the arm and the forearm. The knowledge of the relation between these nerves is very important, when one wants to use one of the nerves for sensory innervation of the flap and the other as a vascularized nerve graft. The practical application of this principle is illustrated by the example of one clinical case.
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