Relation entre le taux de 1,25-dihydroxycholécalciférol et le pronostic fonctionnel après une fracture de hanche chez les personnes âgées

The present treatment of a fracture must allow an anatomical consolidation and an ad integrum functional recuperation. An osteosynthesis giving immediate stability allows for an early rehabilitation, articular and muscular. However, it modifies the biological and mechanical conditions of the spontaneous bony consolidation and determines limits to the physiotherapy according to the type of the fracture, the type of the osteosynthesis and the degree of evolution. A poor osteosynthesis and/or a maladjusted rehabilitation exposes a pathological consolidation.

Évolution chirurgicale de la myélopathie thoracique secondaire à l'ossification des ligaments jaunes

Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved.Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

Démarche d’assurance qualité en chirurgie ambulatoire de la main

Postoperative rehabilitation is a multidisciplinary program that requires participation of anesthetists and surgeons. The development of laparoscopic surgery is one of the components of this program. Rehabilitation requires effective analgesia avoiding the administration of too much opiate because of their side effect on the digestive tract. Postoperative-epidural analgesia with local anesthetics significantly shortens postoperative ileus, but intravenous infusion of lidocaine should have the same effect. The main objectives are reduction in postoperative morbidity and shortening of hospital stay.

Manifestations rhumatologiques de l'infection chronique virale C

The aim of this retrospective study, carried out between January 1992 and April 1995 was to determine the prevalence and characteristics of infection by the hepatitis C virus for a population of HIV+ patients from five psychiatric hospitals in the Ile de France region. To this end, 117 HIV infected patients benefited from : a) a screening program for HCV, HBV, and syphilis antibodies and b) a dosage of transaminases. The associated risk factors were as follows: 64 % of HIV infected patients were drug addicts, 12 % were heterosexuals, 10 % were homosexuals, and 3 % had received a blood transfusion. The precise means of contamination was not established in 11 % of the cases. The prevalence of HIV was 71 % but varied according to the means of contamination. No correlation was found between HCV seropositivity and an increased level of transaminases. 80 % of patients were carriers of at least one hepatitis B marker antibody. The detection of the sole HBc antibody, in the absence of other HBV markers, appeared to be a good indirect marker of hepatitis C. Only 3 % of the patients were screened as responding well to vaccination against hepatitis B (isolated Ac HBs). 6 % of the patients were contaminated by all three viruses, HIV, HCV, and HBV. This study is the first to show, within the psychiatric sphere, that the prevalence of hepatitis C is considerably higher for HIV infected patients. Contamination through intravenous injection of drugs is the most likely cause of infection. A prospective follow up of HIV infected patients is therefore indispensable. Finally, the insufficient number of patients vaccinated against the hepatitis B virus should incite us to relaunch a vaccination programme in our hospital centers.