Since 1995, the authors have created 32 distally based superficial sural artery flaps based on the vascular axis of the sural nerve. The creation of the first 18 flaps permitted the authors to view perforators that issued from the gastrocnemius muscles to the vascular axis of the sural nerve. This led to the development of an anatomic study involving 25 cadaveric dissections to establish a relationship between the gastrocnemius muscles and the vascular axis of the sural nerve, with two to three constant and direct perforators from the gastrocnemius to the neurovascular axis. In this article, the technique for harvesting this new muscular flap is described. Between June of 1997 and March of 1998, three patients underwent flap operations. Two fasciomyocutaneous flaps and one fasciomuscular flap were created and were followed by uncomplicated postoperative courses in terms of flap viability and donor sites. In all cases, the flap created was designed to fill bone defects of the leg (one case) or of the foot (two cases). The results were considered to be excellent and stable over time, with follow-up periods ranging from 9 months to 18 months in duration.

On the basis of 263 male cases of primary chronic pancreatitis from western France, the following factors were analyzed: (1) distribution of the cases according to geological characteristics; (2) data on age, occupation, history, and especially the dietary habits of these patients, stressing the frequency of obesity, excessive food intake, and alcoholism and (3) definition of the course of the disease. The following points were examined: (1) the general profile of pain in the evolution over 15 years; (2) study of some courses which the disease may take (remission of clinical cure, complications, cirrhosis, death); (3) the patient’s condition during the 15 years of illness (weight, disturbance of carbohydrate metabolism, ability to work), and (4) factors influencing the course of the disease (age, pancreatic calcification, alcohol intake, and surgery).

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Intraoperative cholangiograms were studied in 250 patients. Analysis of the data obtained led to the establishment of a protocol for intraoperative cholangiography aimed at identification of anatomical anomalies and variations. Diagnosis of the latter must be achieved in order to avoid possible intraoperative complications. The common hepatic duct was formed by the junction of the right and left hepatic ducts in 52% of the cases studied. Absence of convergence of the posterior and anterior rami of the right hepatic duct was found in 30% of cases. Anatomical variations of the right sectorial duct system were seen in 12% of cases. Conversely, variations of the left sectorial duct system were rarely seen (2% of cases). Careful examination of the intraoperative cholangiograms led us to suspect certain anatomical variations in close to 1% of cases. These variations included abnormal hepatocystic duct, which if undiagnosed could lead to choleperitoneum or inadvertent ligation of the right hepatic duct. An abnormal hepatocystic duct terminating on the gall bladder was found in one patient. Study of the origin of the common bile duct allowed us to define the mode of termination of the cystic duct (on the right margin of the common hepatic duct in 80% of cases) and to identify a short choledochus in 2% of cases. Finally, variations of the duodenal termination of the common bile duct were studied and reflux into the pancreatic duct was seen in 27% of cases. However, the pathological significance of such reflux was rarely found.

In this work we construct a novel associative algebra and use it to define a theory of higher-spin gravity in (2 + 1)-dimensional asymptotically flat spacetimes. Our construction is based on a quotient of the universal enveloping algebra of i s l ( 2 , R ) with respect to the ideal generated by its Casimir elements, the mass squared M 2 and the three-dimensional analogue of the square of the Pauli–Lubanski vector S and propose to call the resulting associative algebra i h s ( M 2 , S ) . We provide a definition of its generators and even though we are not yet able to provide the complete set of multiplication rules of this algebra our analysis allows us to study many interesting and relevant sub-structures of i h s ( M 2 , S ) . We then show how to consistently couple a scalar field to an i h s ( M 2 , S ) higher-spin gauge theory.

Urgotul belongs to a new class of non-adherent dressings: the lipidocolloid dressings. It is composed of an open weave polyester mesh impregnated with hydrocolloid polymers dispersed within petrolatum. The first clinical trial data are presented. Efficacy and safety were evaluated in a multicentre non-comparative trial involving 92 patients treated to healing or up to 4 weeks. Adult outpatients with acute wounds (n = 34), leg ulcers (n = 24), other chronic wounds (n = 14) or with second-degree burns (n = 20) were included. Results showed 32.4% (n = 11) of the acute wounds, 12.5% (n = 3) of the leg ulcers and 14.3% (n = 2) of the other chronic wounds completely healed before 4 weeks. Surface areas decreased on average by 76.4%, 63.5% and 44.2% at study endpoint respectively. For burns, 19 patients healed (95%) within 5-19 days. A total of 771 dressing changes were performed during the course of the study. Dressing application was considered as easy or very easy in 90% or more of the changes and there was no difficulty in removing the dressing in about 95% of the cases. Safety was good with five reports of a transitory local adverse event, probably dressing-related, being observed, two patients (2.2%) prematurely stopped treatment because of moderate periwound erythema. Urgotul is a highly promising new dressing which is currently undergoing further comparative clinical evaluation.

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