195 resultados para TRANSARTICULAR SCREW FIXATION


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Two methods of differential isotopic coding of carboxylic groups have been developed to date. The first approach uses d0- or d3-methanol to convert carboxyl groups into the corresponding methyl esters. The second relies on the incorporation of two 18O atoms into the C-terminal carboxylic group during tryptic digestion of proteins in H(2)18O. However, both methods have limitations such as chromatographic separation of 1H and 2H derivatives or overlap of isotopic distributions of light and heavy forms due to small mass shifts. Here we present a new tagging approach based on the specific incorporation of sulfanilic acid into carboxylic groups. The reagent was synthesized in a heavy form (13C phenyl ring), showing no chromatographic shift and an optimal isotopic separation with a 6 Da mass shift. Moreover, sulfanilic acid allows for simplified fragmentation in matrix-assisted laser desorption/ionization (MALDI) due the charge fixation of the sulfonate group at the C-terminus of the peptide. The derivatization is simple, specific and minimizes the number of sample treatment steps that can strongly alter the sample composition. The quantification is reproducible within an order of magnitude and can be analyzed either by electrospray ionization (ESI) or MALDI. Finally, the method is able to specifically identify the C-terminal peptide of a protein by using GluC as the proteolytic enzyme.

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Objective: Integration of the radiotherapy technologist "know-how" in the Gamma Knife treatment processMaterials and Methods: Gamma Knife (GK) treatments started in July 2010 at the GK Center in C.H.U.V. with the Leksell Gamma KnifeR Perfexion?(Elekta AB, Sweden). The multidisciplinary GK team involves neurosurgeons, radio-oncologists, physicists, neuroradiologists, nurses and technologists, aiming at a full integration for optimal patient management.Results: Between July and December 2010, 60 patients have been treated. Required stereotactic imaging involves IRM, CT scan (and angiography for AVM). All the steps in the treatment process (Leksell coordinate frame fixation, imaging, planning, treatment) are supervised by the members of the multidisciplinary team. In our experience, radiotherapy technologist (RTT) have acquired an important role in the multidisciplinary team communication and integration. Specifically, the RTT are responsible of: supervision of the image acquisition, performing the Gamma Knife unit control tests, patient setup, and patient surveillance during treatment.Conclusion: RTT have a fundamental role in the communication within the team, between the team and the patient and also to assure the patient security. Our experience shows that it is possible and required to involve RTT in all steps of the GK treatment process, to guarantee the best GK treatment possible.

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In our study, 60 infants and children, each with a severe subglottic stenosis (SGS), underwent partial cricotracheal resection (PCTR) with primary thyrotracheal anastomosis. According to the Myer-Cotton classification, two were grade II, 41 were grade III and 17 were grade IV stenoses. Of the 60 patients, 57 (95%) are presently decannulated, and one patient sustained a complete restenosis. Two patients with better than 80% subglottic airways still are waiting for decannulation: one because of bilateral cricoarytenoid joint fixation and the second because of temporary stenting of the subglottis with a Montgomery T-tube. The rate of decannulation is 97% (36 of 37 cases) in primary PCTRs, 100% (13 of 13 cases) in salvage PCTRs for failed laryngotracheal reconstructions (LTR) and 70% (7 of 10 cases) in extended PCTRs (i.e., PCTR associated with an additional open-airway procedure).

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Objectives : Eye movements are necessary to stabilize the retinal picture and to find a new object. This seems useless for blind people, so why do they nevertheless have them. We report on an EOG study on 29 blind volunteers and 5 volunteers with closed eyes. Material and methods: We recorded eye movements by EOG and let the volunteers fulfill different exercises by following an acoustic running point by gaze, pointing, imagining in the room, listing words that begin with the vocal U and a finger labyrinth. Results: We found slow eye movements as well as pathological eye movements in the blind subjects. We found that blind subjects have a horizontal preferency.The duration of fixation of pictures is shorter in the blind subjects. The blind could even modulate saccade amplitudes . Discussion: Eye movements seem to be structural properties of the brain which prepare the organism for certain situations-even if they do not take place. We think that eye movements are partially independent of the experience of view. We did not expect that the blind subjects could modify gaze according to the subject. This leads to the hypothesis of a preformed dimensional system.

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This prospective study addresses early results of the treatment of acute acetabular fractures in elderly patients by total hip arthroplasty and cerclage wiring.Fifteen patients with an average age of 81 years were treated at our institution between February 1998 and December 2000. There were two transverse fractures, eight T-shaped fractures, two transverse fractures with associated posterior wall fracture, two posterior column fractures with associated posterior wall fracture, and one fracture of both columns. Treatment consisted of cerclage wiring of the fracture and primary non-cemented total hip replacement.All of the patients were followed for a mean of 36 months. Although there was one patient with three hip dislocations during the first 10 months after the operation, we found an excellent or good result for the entire group. During this relatively short follow-up period, we have not found a radiological loss of fracture reduction of more than 1 mm or a cup migration of more than 3.2 mm. All of the fractures healed and no loosening of the implant was evident.Primary total hip arthroplasty combined with internal fixation is a valid treatment option for acetabular fractures in the elderly. Preliminary results are convincing, but a bigger patient population and a longer follow-up time are necessary before we are able to draw final conclusions.

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Learning is the ability of an organism to adapt to the changes of its environment in response to its past experience. It is a widespread ability in the animal kingdom, but its evolutionary aspects are poorly known. Learning ability is supposedly advantageous under some conditions, when environmental conditions are not too stable - because in this case there is no need to learn to predict any event in the environment - and not changing too fast - otherwise environmental cues cannot be used because they are not reliable. Nevertheless, learning ability is also known to be costly in terms of energy needed for neuronal synthesis, memory formation, initial mistakes. During my PhD, I focused on the study of genetic variability of learning ability in natural populations. Genetic variability is the basis on which natural selection and genetic drift can act. How does learning ability vary in nature? What are the roles of additive genetic variation or maternal effects in this variation? Is it involved in evolutionary trade-offs with other fitness-related traits?¦I investigated a natural population of fruit fly, Drosophila melanogaster, as a model organism. Its learning ability is easy to measure with associative memory tests. I used two research tools: multiple inbred and isofemale lines derived from a natural population as a representative sample. My work was divided into three parts.¦First, I investigated the effects of inbreeding on aversive learning (avoidance of an odor previously associated with mechanical shock). While the inbred lines consistently showed reduced egg-to-adult viability by 28 %, the effects of inbreeding on learning performance was 18 % and varied among assays, with a trend to be most pronounced for intermediate conditioning intensity. Variation among inbred lines indicates that ample genetic variance for learning was segregating in the base population, and suggests that the inbreeding depression observed in learning performance was mostly due to dominance rather than overdominance. Across the inbred lines, learning performance was positively correlated with the egg-to-adult viability. This positive genetic correlation contradicts previous studies which observed a trade-off between learning ability and lifespan or larval competitive ability. It suggests that much of the genetic variation for learning is due to pleiotropic effects of genes affecting other functions related to survival. Together with the overall mild effects of inbreeding on learning performance, this suggests that genetic variation specifically affecting learning is either very low, or is due to alleles with mostly additive (semi-dominant) effects. It also suggests that alleles reducing learning performance are on average partially recessive, because their effect does not appear in the outbred base population. Moreover, overdominance seems unlikely as major cause of the inbreeding depression, because even if the overall mean of the inbred line is smaller than the outbred base population, some of the inbred lines show the same learning score as the outbred base population. If overdominance played an important part in inbreeding depression, then all the homozygous lines should show lower learning ability than¦outbred base population.¦In the second part of my project, I sampled the same natural population again and derived isofemale lines (F=0.25) which are less adapted to laboratory conditions and therefore are more representative of the variance of the natural population. They also showed some genetic variability for learning, and for three other fitness-related traits possibly related with learning: resistance to bacterial infection, egg-to-adult viability and developmental time. Nevertheless, the genetic variance of learning ability did not appear to be smaller than the variance of the other traits. The positive correlation previously observed between learning ability and egg- to-adult viability did not appear in isofemale lines (nor a negative correlation). It suggests that there was still genetic variability within isofemale lines and that they did not fix the highly deleterious pleiotropic alleles possibly responsible for the previous correlation.¦In order to investigate the relative amount of nuclear (additive and non-additive effects) and extra-nuclear (maternal and paternal effect) components of variance in learning ability and other fitness-related traits among the inbred lines tested in part one, I performed a diallel cross between them. The nuclear additive genetic variance was higher than other components for learning ability and survival to learning ability, but in contrast, maternal effects were more variable than other effects for developmental traits. This suggests that maternal effects, which reflects effects from mitochondrial DNA, epigenetic effects, or the amount of nutrients that are invested by the mother in the egg, are more important in the early stage of life, and less at the adult stage. There was no additive genetic correlation between learning ability and other traits, indicating that the correlation between learning ability and egg-to-adult viability observed in the first pat of my project was mostly due to recessive genes.¦Finally, my results showed that learning ability is genetically variable. The diallel experiment showed additive genetic variance was the most important component of the total variance. Moreover, every inbred or isofemale line showed some learning ability. This suggested that alleles impairing learning ability are eliminated by selection, and therefore that learning ability is under strong selection in natural populations of Drosophila. My results cannot alone explain the maintenance of the observed genetic variation. Even if I cannot eliminate the hypothesis of pleiotropy between learning ability and the other fitness-related traits I measured, there is no evidence for any trade-off between these traits and learning ability. This contradicts what has been observed between learning ability and other traits like lifespan and larval competitivity.¦L'apprentissage représente la capacité d'un organisme à s'adapter aux changement de son environnement au cours de sa vie, en réponse à son expérience passée. C'est une capacité très répandue dans le règne animal, y compris pour les animaux les plus petits et les plus simples, mais les aspects évolutifs de l'apprentissage sont encore mal connus. L'apprentissage est supposé avantageux dans certaines conditions, quand l'environnement n'est ni trop stable - dans ce cas, il n'y a rien à apprendre - ni trop variable - dans ce cas, les indices sur lesquels se reposer changent trop vite pour apprendre. D'un autre côté, l'apprentissage a aussi des coûts, en terme de synthèse neuronale, pour la formation de la mémoire, ou de coûts d'erreur initiale d'apprentissage. Pendant ma thèse, j'ai étudié la variabilité génétique naturelle des capacités d'apprentissage. Comment varient les capacités d'apprentissage dans la nature ? Quelle est la part de variation additive, l'impact des effets maternel ? Est-ce que l'apprentissage est impliqué dans des interactions, de type compromis évolutifs, avec d'autres traits liés à la fitness ?¦Afin de répondre à ces questions, je me suis intéressée à la mouche du vinaigre, ou drosophile, un organisme modèle. Ses capacités d'apprentissage sont facile à étudier avec un test de mémoire reposant sur l'association entre un choc mécanique et une odeur. Pour étudier ses capacités naturelles, j'ai dérivé de types de lignées d'une population naturelle: des lignées consanguines et des lignées isofemelles.¦Dans une première partie, je me suis intéressée aux effets de la consanguinité sur les capacités d'apprentissage, qui sont peu connues. Alors que les lignées consanguines ont montré une réduction de 28% de leur viabilité (proportion d'adultes émergeants d'un nombre d'oeufs donnés), leurs capacités d'apprentissage n'ont été réduites que de 18%, la plus forte diminution étant obtenue pour un conditionnement modéré. En outre, j'ai également observé que les capacités d'apprentissage était positivement corrélée à la viabilité entre les lignées. Cette corrélation est surprenante car elle est en contradiction avec les résultats obtenus par d'autres études, qui montrent l'existence de compromis évolutifs entre les capacités d'apprentissage et d'autres traits comme le vieillissement ou la compétitivité larvaire. Elle suggère que la variation génétique des capacités d'apprentissage est due aux effets pleiotropes de gènes récessifs affectant d'autres fonctions liées à la survie. Ces résultats indiquent que la variation pour les capacités d'apprentissage est réduite comparée à celle d'autres traits ou est due à des allèles principalement récessifs. L'hypothèse de superdominance semble peu vraisemblable, car certaines des lignées consanguines ont obtenu des scores d'apprentissage égaux à ceux de la population non consanguine, alors qu'en cas de superdominance, elles auraient toutes dû obtenir des scores inférieurs.¦Dans la deuxième partie de mon projet, j'ai mesuré les capacités d'apprentissage de lignées isofemelles issues de la même population initiale que les lignées consanguines. Ces lignées sont issues chacune d'un seul couple, ce qui leur donne un taux d'hétérozygosité supérieur et évite l'élimination de lignées par fixation d'allèles délétères rares. Elles sont ainsi plus représentatives de la variabilité naturelle. Leur variabilité génétique est significative pour les capacités d'apprentissage, et trois traits liés à la fois à la fitness et à l'apprentissage: la viabilité, la résistance à l'infection bactérienne et la vitesse de développement. Cependant, la variabilité des capacités d'apprentissage n'apparaît cette fois pas inférieure à celle des autres traits et aucune corrélation n'est constatée entre les capacité d'apprentissage et les autres traits. Ceci suggère que la corrélation observée auparavant était surtout due à la fixation d'allèles récessifs délétères également responsables de la dépression de consanguinité.¦Durant la troisième partie de mon projet, je me suis penchée sur la décomposition de la variance observée entre les lignées consanguines observée en partie 1. Quatre composants ont été examinés: la variance due à des effets nucléaires (additifs et non additifs), et due à des effets parentaux (maternels et paternels). J'ai réalisé un croisement diallèle de toutes les lignées. La variance additive nucléaire s'est révélée supérieure aux autres composants pour les capacités d'apprentissage et la résistance à l'infection bactérienne. Par contre, les effets maternels étaient plus importants que les autres composants pour les traits développementaux (viabilité et vitesse de développement). Ceci suggère que les effets maternels, dus à G ADN mitochondrial, à l'épistasie ou à la quantité de nutriments investis dans l'oeuf par la mère, sont plus importants dans les premiers stades de développement et que leur effet s'estompe à l'âge adulte. Il n'y a en revanche pas de corrélation statistiquement significative entre les effets additifs des capacités d'apprentissage et des autres traits, ce qui indique encore une fois que la corrélation observée entre les capacités d'apprentissage et la viabilité dans la première partie du projet était due à des effets d'allèles partiellement récessifs.¦Au, final, mes résultats montrent bien l'existence d'une variabilité génétique pour les capacités d'apprentissage, et l'expérience du diallèle montre que la variance additive de cette capacité est importante, ce qui permet une réponse à la sélection naturelle. Toutes les lignées, consanguines ou isofemelles, ont obtenu des scores d'apprentissage supérieurs à zéro. Ceci suggère que les allèles supprimant les capacités d'apprentissage sont fortement contre-sélectionnés dans la nature Néanmoins, mes résultats ne peuvent pas expliquer le maintien de cette variabilité génétique par eux-même. Même si l'hypothèse de pléiotropie entre les capacités d'apprentissage et l'un des traits liés à la fitness que j'ai mesuré ne peut être éliminée, il n'y a aucune preuve d'un compromis évolutif pouvant contribuer au maintien de la variabilité.

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Objectives: Total ankle replacement (TAR) is increasingly used for treatment of primary or posttraumatic arthritis of the ankle joint, if joint movement is intended to be preserved. Data on characteristics and treatment of ankle prosthetic joint infection (PJI) is limited and no validated therapeutic algorithm exist. Therefore, we analyzed all infections, which occurred in a cohort of implanted ankle prostheses during a 5-year-period.Methods: Between 06/2004 and 12/2008, all patients with an implanted ankle prosthesis at our institution were retrospectively reviewed. All patients were operated by the same surgical team. Ankle PJI was defined as visible purulence, acute inflammation on histopathology, sinus tract, or microbial growth in periprosthetic tissue or sonication fluid of the removed prosthesis. The surgery on the infected ankle prosthesis and the follow-up were performed by the surgical team, who implanted the prosthesis. A specialized septic team consisting of an orthopaedic surgeon and infectious diseases consultant were included in the treatment.Results: During the study period, 92 total ankle prostheses were implanted in 90 patients (mean age 61 years, range 28-80 years). 78 patients had posttraumatic arthritis, 11 rheumatoid arthritis and 3 other degenerative disorder. Ankle PJI occurred in 3 of 92 TAR (3.3%), occurring 1, 2 and 24 months after implantation; the causative organisms were Enterobacter cloacae, Streptococcus pyogenes and Staphylococcus epidermidis, respectively. The ankle prosthesis was removed in all infected patients, including debridement of the surrounding tissue was debrided and insertion of an antibiotic loaded spacer. Provisional arthrodesis was performed by external fixation in two patients and by plaster cast in one. A definitive ankle arthrodesis with a retrograde nail was performed 6 to 8 weeks after prosthesis removal. One patient needed a flap coverage. All 3 patients received intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 4-6 weeks. At follow-up visit up to 18 months after start of treatment, all patients were without clinical or laboratory signs of infection.Conclusions: The infection incidence after TAR was 3.3%, which is slightly higher than reported after hip (<1%) or knee arthroplasty (<2%). A two-step approach consisting of removal of the infected prosthesis, combined with local and systemic antibiotic treatment, followed by definitive ankle arthrodesis shows good results. Larger patient cohort and longer follow-up evaluation is needed to define the optimal treatment approach for ankle PJI.

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In a prospective study the functional results after dissection or preservation of the serratus anterior muscle in the postero-lateral standard thoracotomy were evaluated. In 14 patients of our clinic with dissection and suture and in 14 patients with preservation of the serratus muscle the muscle function was assessed and compared preoperatively, within the first two post-operative weeks, and three months after the operation by the same physiotherapists. The two groups were blinded in regard to age, original disease, and mode of intervention. We compared the wing position of the scapula in the sitting position and the positioning of the scapula at fixation of the shoulder joint in the sitting and in the supine position. Using a four-grade function assessment scheme, both groups obtained the same functional results. There was no seroma in either group. After 2.8 (2.5 to 3.0) years all the surviving patients described symmetric functional conditions. We therefore conclude that in order to achieve a better view of the operative field the serratus muscle may be dissected close to the origin if it is then readapted.

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Natural selection favors alleles that increase the number of offspring produced by their carriers. But in a world that is inherently uncertain within generations, selection also favors alleles that reduce the variance in the number of offspring produced. If previous studies have established this principle, they have largely ignored fundamental aspects of sexual reproduction and therefore how selection on sex-specific reproductive variance operates. To study the evolution and consequences of sex-specific reproductive variance, we present a population-genetic model of phenotypic evolution in a dioecious population that incorporates previously neglected components of reproductive variance. First, we derive the probability of fixation for mutations that affect male and/or female reproductive phenotypes under sex-specific selection. We find that even in the simplest scenarios, the direction of selection is altered when reproductive variance is taken into account. In particular, previously unaccounted for covariances between the reproductive outputs of different individuals are expected to play a significant role in determining the direction of selection. Then, the probability of fixation is used to develop a stochastic model of joint male and female phenotypic evolution. We find that sex-specific reproductive variance can be responsible for changes in the course of long-term evolution. Finally, the model is applied to an example of parental-care evolution. Overall, our model allows for the evolutionary analysis of social traits in finite and dioecious populations, where interactions can occur within and between sexes under a realistic scenario of reproduction.

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OBJECTIVES: A straightforward original Chimney Graft (CG) protocol has been developed at our institution in selected cases of juxtarenal aortic aneurysm (JRAA). The aim of this study was to present our clinical experience of consecutive series with use of uncovered self-expanding stent (SES) as "Open Chimney" (OCh) in the endovascular repair (EVAR) of JRAA. METHODS: A standard endograft with suprarenal fixation struts is delivered with its proximal covered edge just below the highest RA in JRAA presenting the ostium of the two renal arteries at a different aortic level and the distance between the highest renal artery and the beginning of the aneurysm (improved landing zone) ≥10 mm. The low-lying renal artery is maintained patent by the OCh graft (standard SES) delivered from left brachial access (6 Fr). All clinical, anatomical, and operative data were prospectively collected and retrieved for the study analysis. RESULTS: From July 2010 to November 2012, OCh EVAR was offered to 22 consecutive patients considered unfit for JRAA open repair. All procedures were technically successful with aneurysm exclusion and patent OCh graft. One small perioperative type Ia endoleak spontaneously disappeared at the 3-month CT control. One patient died because of acute decompensated heart failure. One patient presented a left hemispheric stroke. The median follow-up of 18 months (range 7-35) showed aneurysm exclusion in all patients without type I and III endoleaks, SES stenosis, and/or renal impairment. CONCLUSIONS: OCh-EVAR is a straightforward technique that can be employed in selected cases of JRAA, avoiding the more complex and expensive fenestrated EVAR.

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BACKGROUND AND AIMS: Mannan-binding lectin (MBL) and ficolins are microbial pattern recognition molecules that activate the lectin pathway of complement. We previously reported the association of MBL deficiency with anti-Saccharomyces cerevisiae antibodies (ASCA) in patients with Crohn's disease (CD). However, ASCA are also frequently found in MBL-proficient CD patients. Here we addressed expression/function of ficolins and MBL-associated serine protease-2 (MASP-2) regarding potential association with ASCA. METHODS: ASCA titers and MBL, ficolin and MASP-2 concentrations were determined by ELISA in the serum of patients with CD, ulcerative colitis (UC), and in healthy controls. MASP-2 activity was determined by measuring complement C4b-fixation. Anti-MBL autoantibodies were detected by ELISA. RESULTS: In CD and UC patients, L-ficolin concentrations were significantly higher compared to healthy controls (p<0.001 and p=0.029). In contrast, H-ficolin concentrations were slightly reduced in CD and UC compared to healthy controls (p=0.037 for UC vs. hc). CD patients with high ASCA titers had significantly lower H-ficolin concentrations compared to ASCA-low/negative CD patients (p=0.009). However, MASP-2 activity was not different in ASCA-negative and ASCA-positive CD patients upon both, ficolin- or MBL-mediated MASP-2 activation. Finally, anti-MBL autoantibodies were not over-represented in MBL-proficient ASCA-positive CD patients. CONCLUSIONS: Our results suggest that low expression of H-ficolin may promote elevated ASCA titers in the ASCA-positive subgroup of CD patients. However, unlike MBL deficiency, we found no evidence for low expression of serum ficolins or reduced MASP-2 activity that may predispose to ASCA development.

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In order for some patients to benefit from aggressive chemotherapy for invasive breast carcinoma, many patients are currently being treated without little or no benefit. Enormous effort is hence being directed towards the identification of those patients who will need chemotherapy and those who will not. Since chemotherapy targets proliferating cells pathologists focus on the proliferative activity of tumors, as assessed by mitotic figure counts or by cell cycle specific immunohistochemical markers, such as Ki-67 and H3 histone. As far as the tumor grade is concerned, many of these studies have reported a tendency to up-grade carcinomas in resection specimen when compared to the initial diagnosis on the biopsy material, and most studies have noted that the upgrade in resection specimen is due solely or to a large extent to an increase in the mitotic figure count. In the present study, we propose a different explanation for the divergence in mitotic figure counts between biopsy and resection material. We assessed the proliferative activity of 52 invasive ductal carcinomas and confirm that the number of mitotic figures significantly increased by a factor of more than 3 in resection specimen over the biopsy material, while at the same time the pan-cell cycle specific marker MIB-1 yieldes comparable results. we propose that the delayed formalin fixation of resection specimen allows cell cycle activities to continue for a long time, up to many hours, and that this leads to an arrest of mitoses in metaphase where they are readily identified by the pathologist. We propose that the mitotic figure count in the rapidly fixed biopsy cores better represent the tumor biology and should be used as a basis for chemotherapy therapeutic decisions.

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The establishment of arbuscular mycorrhizal (AM) symbioses, formed by most flowering plants in association with glomeromycotan fungi, and the root-nodule (RN) symbiosis, formed by legume plants and rhizobial bacteria, requires an ongoing molecular dialogue that underpins the reprogramming of root cells for compatibility. In both endosymbioses, there are distinct phases to the interaction, including a presymbiotic anticipation phase and, subsequently, an intraradical accommodation of the microsymbiont. Maintenance of the endosymbiosis then depends on reciprocal nutrient exchange with the microsymbiont-obtaining plant photosynthates in exchange for mineral nutrients: enhanced phosphate and nitrogen uptake from AM fungi and fixed nitrogen from rhizobia. Despite the taxonomically distinct groups of symbionts, commonalities are observed in the signaling components and the modulation of host cell responses in both AM and RN symbioses, reflecting common mechanisms for plant cell reprogramming during endosymbiosis.

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Introduction: Isolated avulsion fracture at the plantar lateral base of the first metatarsal (M1) is very rare. Case report: A 35 year old overweight woman sustained an eversion strain of her right foot. Despite pain along M1 she was able to continue walking for three days before presenting to her family doctor. Swelling on the plantar aspect of the foot was noticed, there was also pain at eversion of the foot and extension of the ankle. Plain X-ray showed no abnormalities. A MRI showed minimal bone bruise at the basis of M1 and a partial rupture of the peroneus longus tendon at its insertion. The patient was allowed to walk with partial weight bearing with a soft ankle brace. After 6 months she presented at our hospital because of persistent pain. There was still a painful insertion of the peroneus longus but active plantarflexion of M1 was possible. Plain X-rays were poorly contributive except for a discrete flattening of the longitunal arch. CT-scan showed a non displaced fracture at the M1-basis. A protocol with partial weight-bearing in a short-leg cast and partial weight-bearing orthosis each for 6 weeks was unsuccessfully attempted. Therefore, an excision of the non healed bone fragment at the basis of M1 and a first tarsometatarsal joint arthrodesis were performed. Postoperatively the patient wore a partial weight-bearing short leg cast for 6 weeks followed by a weight-bearing short leg cast for 6 weeks with favourable outcome. Discussion: Initial internal fixation has been reported to lead to good results [1, 2]. In our case the conservative treatment failed and leaded to non union. At that time we considered as too risky (overweight) to excise the fragment and reattach the peroneus longus tendon. Therefore, we excised the fragment and fused the first tarsometatarsal joint. This procedure allowed, at least partially, to compensate for the function of the peroneus longus tendon. 1 Murakami T, et al. Avulsion fracture of the peroneus longus at the first metatarsal insertion: a case report. Br J Sports Med. 2004. 2 Kwak HY, and Bae SW. Isolated avulsion fracture at the plantar lateral base of the first metatarsal: a case report. Foot Ankle Int 2000.

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Summary Artificial radionuclides were released in the environment during the atmospheric nuclear weapon tests and after accidental events involving nuclear industries. As a primary receptor of the deposition, the soil is a very sensitive compartment and understanding the interaction and migration of radionuclides within soils allows the development of scenario for the contamination risk of the population and of the environment. Most available field studies on radionuclides in soils only concern one or two isotopes, mostly 137Cs, and few physico-chemical soil parameters. The purpose of this study was a broader understanding of the radioecology of an Alpine valley. In a first part, we aimed to describe the depth distribution of 137Cs, 90Sr, 239+240Pu, and 241Am within different alpine soils and to identify some stable elements as indicators for accumulating layers. In the central part of the study, the goal was to investigate the repartition of ^Sr and 239Pu between the truly dissolved fraction and the colloidal fraction of the soil solutions and to identify the nature of colloids involved in the adsorption of ^Sr and 239Pu. These results were integrated in an "advection- sorption" transport model seeking to explain the migration of 239Pu and 90Sr within the soils and to assess the importance of colloidal transport for these two isotopes. A further aspect studied was the role of the competition between the radioisotopes (137Cs and 90Sr) and their stable chemical analogues (K and Ca) with respect to plant uptake by different plant species. The results on the depth distribution within the soils showed that 137Cs was mostly retained in the topsoil, to the exception of an organic-rich soil (Histosol 2) receiving important surface runoff, where migration down to a depth of 30 cm was observed. 137Cs depth distribution within the soils was similar to unsupported 210Pb depth distribution. The plant uptake of 137Cs clearly depended on the concentration of exchangeable potassium in the soils. Moreover, we showed that the 137Cs uptake by certain species of the taxonomic orders Poales and Rosales was more sensitive to the increase in exchangeable Κ compared to other orders. Strontium-90 was much more mobile in the soils than 137Cs and depth migration and accumulation in specific AI- and Fe-rich layers were found down to 30 cm. Copper and Ni showed accumulations in these same layers, indicating their potential to be used as indicators for the migration of ^Sr within the soils. In addition, we observed a 90Sr activity peak in the topsoil that can be attributable to recycling of 90Sr by plant uptake. We demonstrated for the first time that a part of 90Sr (at least 40%) was associated with the colloids in organic-rich soil solutions. Therefore, we predict a significant effect of the colloidal migration of ^Sr in organic-rich soil solutions. The plant uptake results for 90Sr indicated a phylogenetic effect between Non-Eudicot and Eudicots: the order Poales concentrating much less 90Sr than Eudicots do. Moreover, we were able to demonstrate that the sensitivity of the 90Sr uptake by 5 different Alpine plant species to the amount of exchangeable Ca was species-independent. Plutonium and 241Am accumulated in the second layer of all soils and only a slight migration deeper than 20 cm was observed. Plutonium and 241Am showed a similar depth distribution in the soils. The model results suggested that the present day migration of 239Pu was very slow and that the uptake by plants was negligible. 239Pu activities between 0.01 to 0.08 mBq/L were measured in the bulk soil solutions. Migration of 239Pu with the soil solution is dominated by colloidal transport. We reported strong evidences that humic substances were responsible of the sorption of 239Pu to the colloidal fraction of the soil solutions. This was reflected by the strong correlation between 239Pu concentrations and the content of (colloidal) organic matter in the soil solution. Résumé Certains radioéléments artificiels ont été disséminés dans l'environnement suite aux essais atmosphériques de bombes nucléaires et suite à des accidents impliquant les industries nucléaires. En tant que récepteur primaire de la déposition, le sol est un compartiment sensible et des connaissances sur les interactions et la migration des radioéléments dans le sol permettent de développer des modèles pour estimer la contamination de la population et de l'environnement. Actuellement, la plupart des études de terrain sur ce sujet concernent uniquement un ou deux radioéléments, surtout le 137Cs et peu d'études intègrent les paramètres du sol pour expliquer la migration des radioéléments. Le but général de cette étude était une compréhension étendue de la radio-écologie d'une vallée alpine. Notre premier objectif était de décrire la distribution en profondeur de 137Cs, ^Sr, 239+240pu et 241Am dans différents sols alpins en relation avec des éléments stables du sol, dans le but d'identifier des éléments stables qui pourraient servir d'indicateurs pour des horizons accumulateurs. L'objectif de la deuxième partie, qui était la partie centrale de l'étude, était d'estimer le pourcentage d'activité sous forme colloïdale du 239Pu et du 90Sr dans les solutions des sols. De plus nous avons déterminé la nature des colloïdes impliqués dans la fixation du ^Sr et 239Pu. Nous avons ensuite intégré ces résultats dans un modèle de transport développé dans le but de décrire la migration du 239Pu et 90Sr dans le sol. Finalement, nous avons étudié l'absorption de 137Cs et 90Sr par les plantes en fonction de l'espèce et de la compétition avec leur élément analogue stable (K et Ca). Les résultats sur la migration en profondeur du 137Cs ont montré que ce radioélément était généralement retenu en surface, à l'exception d'un sol riche en matière organique dans lequel nous avons observé une nette migration en profondeur. Dans tous les sols, la distribution en profondeur du 137Cs était corrélée avec la distribution du 210Pb. L'absorption du 137Cs par les plantes, était dépendante de la concentration en Κ échangeable dans le sol, le potassium étant un compétiteur. De plus, nous avons observé que les espèces ne réagissaient pas de la même manière aux variations de la concentration de Κ échangeable. En effet, les espèces appartenant aux ordres des Poales et des Rosales étaient plus sensibles aux variations de potassium échangeable dans le sol. Dans tous les sols Le 90Sr était beaucoup plus mobile que le 137Cs. En effet, nous avons observé des accumulations de 90Sr dans des horizons riches en Fe et Al jusqu'à 30 cm de profondeur. De plus, le Cu et le Ni montraient des accumulations dans les mêmes horizons que le 90Sr, indiquant qu'il pourrait être possible d'utiliser ces deux éléments comme analogues pour la migration du 90Sr. D'après le modèle développé, le pic de 90Sr dans les premiers centimètres du sol peut être attribué à du recyclage par les plantes. Le 90Sr en solution était principalement sous forme dissoute dans des solutions de sols peu organique (entre 60 et 100% de 90Sr dissous). Par contre, dans des solutions organiques, un important pourcentage de 90Sr (plus de 40%) était associé aux colloïdes. La migration colloïdale du 90Sr peut donc être significative dans des solutions organiques. Comme pour le 137Cs, l'absorption du 90Sr par les plantes dépendait de la concentration de son analogue chimique dans la fraction échangeable du sol. Par contre, les espèces de plantes étudiées avaient la même sensibilité aux variations de la concentration du calcium échangeable. Le plutonium et l'américium étaient accumulés dans le deuxième horizon du sol et nous avons observé seulement une faible migration plus profondément que 20 cm. Selon le modèle, la migration actuelle du plutonium est très lente et l'absorption par les plantes semble négligeable. Nous avons mesuré entre 0.01 et 0.08 mBq/L de 239Pu dans les solutions de sol brutes. La migration du plutonium par la solution du sol est due principalement aux colloïdes, probablement de nature humique. Résumé grand public Dans les années 1950 à 1960, l'environnement a été contaminé par des éléments radioactifs (radioéléments) artificiels provenant des essais des armes atomiques et de l'industrie nucléaire. En effet, durant ces années, les premiers essais de bombes atomiques se faisaient dans l'atmosphère, libérant de grandes quantités d'éléments radioactifs. De plus certains accidents impliquant l'industrie nucléaire civile ont contribué à la dissémination d'éléments radioactifs dans l'environnement. Ce fut par exemple le cas de l'accident de la centrale atomique de Tchernobyl en 1986 qui a causé une importante contamination d'une grande partie de l'Europe par le 137Cs. Lorsqu'ils sont libérés dans l'atmosphère, les radioéléments sont dispersés et transportés par les courants atmosphériques, puis peuvent être déposés dans l'environnement, principalement par les précipitations. Une fois déposés sur le sol, les radioéléments vont interagir avec les composants du sol et migrer plus ou moins vite. La connaissance des interactions des éléments radioactifs avec le sol est donc importante pour prédire les risques de contamination de l'environnement et de l'homme. Le but général de ce travail était d'évaluer la migration de différents éléments radioactifs (césium-137, strontium-90, plutonium et américium-241) à travers le sol. Nous avons choisi un site d'étude en milieu alpin (Val Piora, Tessin, Suisse), contaminé en radioéléments principalement par les retombées de l'accident de Tchernobyl et des essais atmosphériques de bombes atomiques. Dans un premier temps, nous avons caractérisé la distribution en profondeur des éléments radioactifs dans le sol et l'avons comparée à divers éléments stables. Cette comparaison nous a permit de remarquer que le cuivre et le nickel s'accumulaient dans les mêmes horizons du sol que le strontium-90 et pourraient donc être utilisés comme analogue pour la migration du strontium-90 dans les sols. Dans la plupart des sols étudiés, la migration du césium-137, du plutonium et de l'américium-241 était lente et ces radioéléments étaient donc accumulés dans les premiers centimètres du sol. Par contre, le strontium-90 a migré beaucoup plus rapidement que les autres radioéléments si bien qu'on observe des accumulations de strontium-90 à plus de 30 cm de profondeur. Les radioéléments migrent dans la solution du sol soit sous forme dissoute, soit sous forme colloïdale, c'est-à-dire associés à des particules de diamètre < Ιμηι. Cette association avec des colloïdes permet à des radioéléments peu solubles, comme le plutonium, de migrer plus rapidement qu'attendu. Nous avons voulu savoir quelle était la part de strontium-90 et plutonium associés à des colloïdes dans la solution du sol. Les résultats ont montré que le plutonium en solution était principalement associé à des colloïdes de type organique. Quant au strontium-90, ce dernier était en partie associé à des colloïdes dans des solutions de sol riches en matière organique, par contre, il était principalement sous forme dissoute dans les solutions de sol peu organiques. L'absorption de radioéléments par les plantes représente une voie importante pour le transfert vers la chaîne alimentaire, par conséquent pour la contamination de l'homme. Nous avons donc étudié le transfert du césium-137 et du strontium-90 de plusieurs sols vers différentes espèces de plantes. Les résultats ont montré que l'absorption des radioéléments par les plantes était liée à la concentration de leur analogue chimique (calcium pour le strontium-90 et potassium pour le césium- 137) dans la fraction échangeable du sol. De plus certaines espèces de plantes accumulent significativement moins de strontium-90.