Arthroscopic Subtalar Arthrodesis after a Calcaneus Fracture Covered with a Forearm Flap

Surgical treatment of intraarticular calcaneal fractures is often associated with postoperative wound problems. Soft tissue necrosis, bone loss and uncontrollable infection are a challenge for the surgeon and amputation may in some cases be the ultimate solution. A free flap can be very helpful to cover a significant soft tissue defect and help in fighting the infection. However, the free flap complicates the surgical approach if subtalar arthrodesis and bone reconstruction are needed. This study demonstrates the value of an arthroscopic technique to resect the remaining articular cartilage in preparation for subtalar arthrodesis and bone grafting. This approach avoids compromising the soft tissues and minimizes damage to the free flap

Développement de nouveaux catalyseurs à base de ruthénium pour l'oxydation : vers des systèmes photoactivables.

Ce travail de thèse repose sur le développement de nouveaux catalyseurs d'oxydation utilisant les principes de la chimie verte. Dans un premier temps, afm d'exploiter les propriétés d'induction des complexes tris-diimine de ruthénium en catalyse asymétrique, des complexes hétérodinucléaires Ru-Mn et Ru-Zn ont été synthétisés et caractérisés. Ces complexes sont constitués de l'association d'une entité chirale de ruthénium et d'un fragment de type Mn- ou Zn-salen. Une espèce Ru(II)-Mn(IV) a notamment été caractérisée et un transfert très efficace d'électrons du centre ruthénium excité vers le centre manganèse a également été mis en évidence. Par contre, leur activité catalytique lors d'oxydation d'alcènes s'est avérée être relativement modeste. Dans la seconde partie, nous nous sommes attachés à exploiter simultanément les propriétés photosensibles et catalytiques des complexes de ruthénium. Ainsi, des systèmes homodinucléaires ont été synthétisés et également complètement caractérisés. Ces systèmes se sont montrés particulièrement efficaces lors de l'oxydation de sulfures sous irradiation lumineuse, en utilisant l'eau comme seule source d'atome d'oxygène et un sel ce Co(III) comme accepteur d'électron. Dans le contexte du développement d'une chimie plus respectueuse de l'environnement, nous avons montré que la combinaison d'un photosensiblisateur et de l'énergie lumineuse permettait d'utiliser des conditions douces pour réaliser des réactions d'oxydation.This the sis deals with the development of new homo and heterodinuclear complexes. At fIrst, with the objective to use chiral properties of tris-diimine ruthenium complexes in asymmetric catalysis, modifIed manganese salen complexes constituted by the assembly of a ruthenium and Mn or Zn-salen fragments were synthesized and fully characterized. More particularly, a Ru(II)-Mn(IV) species was characterized and a very efficient electron transfer has been also observed from the excited state of the ruthenium to the manganese. ln the second part of the thesis, the photo sensitive and the catalytic properties of ruthenium complexes were both associated within a unique complex. Two chromophore catalyst dyad families were synthesized and fully characterized. Both of them showed high abilities to convert sulfIdes into sulfoxides under light exposure, using water as the only source of oxygen atom and a Co(III) salt as electron acceptor. ln the context of sustainable development, we have shown that the association of a photosensitizer and solar energy allow soft conditions to perform oxidation reactions.GRENOBLE1-BU Sciences (384212103) / SudocSudocFranceF

Résultats cliniques et fonctionnels du traitement de l incontinence urinaire à l effort par la voie rétro-pubienne (TVT) et trans-obturatrice (TOT et TVT-O) en cas d insuffisance sphinctérienne (PCUM<30cmH2O) (étude comparative chez 162 patientes)

Introduction : La prise en charge chirurgicale de l incontinence urinaire d effort chez des patientes présentant une insuffisance sphinctérienne montre encore des incertitudes. Alors que la voie rétro-pubienne (TVT) montre des résultats satisfaisant dans cette indication, la voie trans-obturatrice est encore peu évaluée. Il semble donc intéressant de comparer ces deux techniques dans l insuffisance sphinctérienne. But de l étude : L objectif de cette étude est de comparer le traitement chirurgical de la cure d incontinence urinaire d effort par la voie rétro-pubienne et par la voie trans-obturatrice chez 162 patientes (97 TVT et 65 TOT ou TVT-O) présentant une insuffisance sphinctérienne avec une pression de clôture uréthrale maximale inférieure à 30 cmH2O. Matériels et méthodes : Il s agit d une étude rétrospective d une population de 162 patientes présentant une insuffisance sphinctérienne avec une pression clôture uréthrale maximale inférieure à 30 cmH2O. Quatre vingt dix sept patientes avaient été opérées par la voie rétro-pubienne (TVT) et 65 patientes par la voie trans-obturatrice (TOT et TVT-O). L interrogatoire et l examen clinique, avec notamment des tests à l effort, une appréciation de la gêne sur une échelle visuelle analogique et la quantification des garnitures, étaient réalisés en pré et post opératoire. Toutes les patientes avaient dans le bilan pré-opératoire un bilan urodynamique. Trois questionnaires ont été envoyés (un questionnaire général, le questionnaire Contilife et un questionnaire sexuel) permettant d évaluer la satisfaction globale des patientes. Les résultats ont été soumis à une analyse statistique. Résultats : Le recul médian était de 8 mois pour les deux groupes (avec des écarts de 1 à 32 mois pour le TOT et 1 à 97 mois pour le TVT). La population des 2 groupes étudiés sont comparables. Le taux d échec objectif (fuites aux efforts de toux vessie en réplétion) était de 36% dans le groupe TVT contre 21% dans le groupe TOT (p=0,49). Le taux d échecs subjectifs (à l interrogatoire) était de 4,1% dans le groupe TVT contre 4,6% dans le groupe TOT (NS). Les questionnaires avec un recul de 3 ans dans le groupe TOT et de 8 ans dans le groupe TVT, ont montré une satisfaction à 4,5/5 et à 4/5 respectivement, sans différence statistiquement significative (p=0,32). Conclusion : Les deux techniques sont efficaces dans l indication d incontinence urinaire avec insuffisance sphinctérienne. Tant sur le plan clinique que sur la satisfaction des patientes, les 2 techniques semblent d une efficacité identiqueIntroduction: Treatment of stress urinary incontinence in patients with low urethral closure pressure still shows uncertainty. Whereas the retro-pubic route (TVT) shows satisfying results in this indication, the trans-obturator route is less evaluated. It thus seems interesting to compare these two techniques in patients with intrinsic sphincter deficiency. Objective: The aim of this study is to compare tension free vaginal tape with trans-obturator tape in 162 patients (97 TVT and 65 TOT or TVT-O) with low maximum urethral closure pressure (PCUM < 30 cmH2O). Study design: it is a retrospective study of a population of 162 patients with an intrinsic sphincter deficiency, with maximum urethral closure pressure of 30 cmH2O or less. Ninety seven patients had been operated by the retro-pubic way (TVT) and 65 patients by the trans-obturator way (TOT or TVT-O). Interview and clinical examination were carried out in pre and post operating time. Three questionnaires were sent (a general questionnaire, the contilife, and a sexual questionnaire) in purpose to evaluate the global satisfaction. The results were subjected to a statistical analysis. Results: Follow up was 8 month for each group (with variations from 1 to 32 month for TOT and 1 to 97 month for TVT). Population of each group is comparable. The evaluation found 36% of objective failure in TVT and 21% in TOT (p=0, 49). Subjective rate failure is 4, 1% in TVT and 4, 6% in TOT (NS). The questionnaires with a 3 years follow up in group TOT and 8 years in group TVT, showed a satisfaction of 4,5/5 and 4/5 respectively (p=0,32). Conclusion: These two techniques are effective in stress urinary incontinence with intrinsic sphincter deficiency. On the clinical level and on satisfaction patients, these 2 techniques seem to have an identical effectivenessPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Endoscopic Treatment of Intrasheath Peroneal Tendon Subluxation

Intrasheath subluxation of the peroneal tendons within the peroneal groove is an uncommon problem. Open exploration combined with a peroneal groove-deepening procedure and retinacular ree�ng is the recommended treatment. is extensive lateral approach needs incision of the intact superior peroneal retinaculum and repair aerwards. We treated three patients with a painful intrasheath subluxation using an endoscopic approach. During this tendoscopy both tendons were inspected. e distal muscle �bers of the peroneus brevis tendon were resected in two patients. A partial tear was debrided in the third patient. All patients had a good result. No wound-healing problems or other complications occurred. Early return to work and sports was possible. An endoscopic approach was successful in treatment of an intrasheath subluxation of the peroneal tendons

Complexation to [Ru(bpy)2]2+: the trick to functionalize 3,3′-disubstituted-2,2′-bipyridine

International audienceWhile many papers reported the synthesis and chemical transformations of x,x′-disubstituted-2,2′-bipyridine with x = 4, 5 or 6, this is not the case when x = 3. Though, such 3,3′-disubstituted-2,2′-bipyridines would be a useful building block for the design of new original complexes. Here we report the results of our investigation concerning the synthesis of members of this family. This study led to the formation of several [(2,2′-bipyridine)2Ru(3,3′-dialkylated-2,2′-bipyridine)]2+ complexes highlighting a surprising chemical behaviour of the 3,3′-disubstituted-2,2′-bipyridine ligand compared to its 4,4′, 5,5′ and 6,6′-homologues

Percutaneous Bunionette correction : a cadaveric Study

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Endoscopic reconstruction of CFL and the ATFL with a gracilis graft : a cadaveric study

The purpose of this study was to evaluate a step-by-step approach to endoscopic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). Fourteen lower extremity cadaveric specimens were used. Four standard portals were defined and used. A step-by-step approach using several anatomical landmarks was used to reconstruct the ATFL and CFL. The feasibility of visualising the anatomical landmarks and both ligaments and their footprints was assessed. Both ligaments were reconstructed using a gracilis graft fixed in bone tunnels. The lateral side of the ankle was completely exposed and dissected. The specimen was assessed for clinical stability of the reconstruction and damage to the surrounding anatomical structures. The distance between the centre of the tunnel and the anatomical insertions of the ligaments was measured. The distance between the portals and the nerves was measured. The step-by-step approach allowed a good visualisation of the entire course of the ATFL and CFL. An endoscopic reconstruction of both ligaments was performed, and good stability was obtained. The measurements revealed a good positioning of the reconstructed ligament insertions with a maximal error of 2 mm in most specimens. Anatomical dissection revealed no damage to the surrounding anatomical structures that were at risk. The average distance to the superficial peroneal nerve was 11.9 +/- A 5.3 mm (standard deviation), and the average distance to the sural nerve was 17.4 +/- A 3.2 mm (standard deviation). A safe zone was defined with regard to the surrounding nerves. The described technique, which involves an anatomical endoscopic reconstruction of the ATFL and CFL, using a gracilis graft, is a viable option to treat lateral ankle instability. This technique is reproducible and safe with regard to the surrounding anatomical structures

Photocatalyzed Sulfide Oxygenation with Water as the Unique Oxygen Atom Source

In our research program aiming to develop new ruthenium-based polypyridine catalysts for oxidation we were interested in combining a photosensitizer and a catalytic fragment within the same complex to achieve catalytic light-driven oxidation. To respond to the lack of such conjugates, we report here a new catalytic system capable of using light to activate water molecules in order to perform selective sulfide oxygenation into sulfoxide via an oxygen atom transfer from H2O to the substrate with a TON of up to 197 ± 6. On the basis of electrochemical and photophysical studies, a proton-coupled electron-transfer process yielding to an oxidant Ru(IV)-oxo species was proposed. In particular, the synergistic effect between both partners in the dyad yielding a more efficient catalyst compared to the bimolecular system is highlighted