Immobilités laryngées unilatérales après chirurgie de la glande thyroïde

Background

The authors studied a cohort of 154 patients with unilateral vocal cord paresis following thyroidectomy, analyzing the pathogenesis, symptomatology, spontaneous evolution, and management of this complication.

Objective

This retrospective study distinguished between vocal cord paresis due to recurrent laryngeal nerve injury or due to injury of the cricoarytenoid articulation. We assessed the influence multiple variables on therapeutic management. The results and complications of currently-employed surgical techniques to remedy unilateral vocal cord paresis were defined.

Patients and methods

Injury to the recurrent laryngeal nerve was the cause of vocal cord paresis in 98% of cases; injury to the cricoarytenoid articulation accounted for only 2% of cases. When the recurrent laryngeal nerve had not been actually transected, spontaneous recovery of vocal cord function occurred in 36% of cases. No spontaneous recovery was noted when the nerve had been divided. The interval to recovery of cord function ranged from 2 to 15 months (median: 4 months). Spontaneous recovery of vocal cord function had occurred in 90% of these patients by the 9th postoperative month. Three factors significantly influenced the decision to perform a median transposition of the injured vocal cord: known transection of the recurrent laryngeal nerve, the interval to consultation with an ENT specialist, and the severity of dysphonia. Medial transposition of the injured vocal cord resulted in an immediate improvement in the quality of voice and speech with no major complications.

Conclusion

Unilateral vocal cord paresis occurring after thyroidectomy is not always symptomatic and is not uniformly due to injury of the recurrent laryngeal nerve. Management does not always require surgical reintervention. The practical and medico-legal consequences of these injuries are discussed.     

Optimisations du profil et de la visée de la tige centro-médullaire pour la pose d'une prothèse de genou

Résumé Les performances mécaniques des prothèses du genou sont dépendantes de la forme des pièces prothétiques et de la précision des coupes osseuses. Les coupes fémorales sont effectuées en prenant comme référence l'axe centro-médullaire matérialisé par une tige droite. Cette tige ne respectant malheureusement pas la courbure sagittale du fémur entraîne ainsi une erreur de positionnement angulaire. Pour respecter la forme anatomique du canal centro-médullaire, il est nécessaire d'utiliser des tiges courbes. Une étude mécanique permet d'abord d'affirmer que la forme de l'axe centro-médullaire peut être assimilée à celle d'un arc de cercle. Les auteurs proposent trois tiges s'ajustant au mieux au canal médullaire puisqu'elles limitent l'erreur de positionnement angulaire à 1,9°. Ces tiges courbes permettent de réaliser un meilleur positionnement des prothèses et donc d'améliorer leurs performances mécaniques.     

Cáncer de recto: qué pacientes se benefician de la radioterapia

The prognosis of patients with rectal cancer has improved in recent years, particularly as regards the lower probability of local recurrence. These positive results are obtained through correct preoperative staging and an adequate surgical resection of the affected lesion, as well as a multidisciplinary therapeutic approach. Based on the available scientific evidence, our aim is to clarify the framework in which options for the right therapy can be taken, especially in relation to the preoperative staging and its limitations, with regards to radiotherapy and its indications. We also emphasize the need of a tailor-made approach for each case.     

Induction de la chondrogenèse de réparation

Various experimental models have been used in young rabbits to determine the conditions necessary to induce chondrogenesis in the inner layer of periosteum after injury. Chondrogenesis will always occur in the presence of a haematoma, torn periosteum and bone, but if one of these factors in missing such a response may not necessarily occur.     

Aplasia cutis congenita du vertex avec atteinte osseuse : synthèse sur la prise en charge et revue de la littérature

Aplasia cutis congenita (ACC) of the vertex is a rare and potentially severe malformation. We report the case of a newborn boy presenting ACC of the vertex with a skull defect. Surgical closure of the skin was performed 5 days following birth, which allowed skin healing. The skull spontaneously remodelled perfectly 6 months later. When associated with skull defect, this rare malformation characterized by the absence of skin carries the risk of severe complications such as rupture of the superior sagittal sinus or infections. Based on a review of the literature, we purpose an overview of the medical and surgical management of vertex ACC, which depends on the size of the skin defect and the presence of a skull defect.     

A propos de 87 luxations de prothèse totale de la hanche

Résumé Sur 1571 prothèses totales consécutives, placées pour la plupart par voie postérieure de Moore, 87 luxations ont été observées dont 9 immédiates, et presque toutes dans les 5 premières semaines; 26 fois sur 87 la luxation s'est reproduite. Onze fois il a fallu réopérer.La comparaison des 87 cas luxés avec les 1584 non luxés montre une fréquence plus grande après les reprises de hanches déjà opérées, ainsi que l'influence de l'expérience du chirurgien et le rôle préventif efficace de la reconstitution du plan profond des muscles pelvi-trochantériens. Quand une instabilité a été constatée en fin d'intervention, la luxation s'est produit 18 fois sur 20.L'influence de la position des pièces n'a pu être comparée qu'avec une série de 100 cas non luxés pris au hasard. Elle semble montrer l'influence de la verticalisation du cotyle, de la rétroversion du cotyle et de celle du fémur, plus nette si on considére les cas récidivés.La comparaison de 331 prothèses à tête de 22 mm avec 29 luxations (8,7%) et de 168 prothèses à tête de 32, avec 5 luxations (2,9%) serait plutôt en faveur du dernier matériel.

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Dislocation after total hip replacement

Summary Eighty seven dislocations were seen in 1571 consecutive total hip replacements, mostly performed through a posterior approach. Nine occurred immediately after operation and most of the remainder within 5 weeks. In 26 cases further dislocation occurred, and in 11 patients another operation was required.The 87 dislocated hips have been compared with the remaining 1484. Factors predisposing to dislocation included revision operations, the experience of the surgeon and proper reconstruction of the abductor musculature. When the hip was deemed unstable at the end of an operation, dislocation occurred on 18 occasions out of 20 such cases.The position of the components in the dislocated hips was compared with that in 100 stable prostheses chosen by random sampling. A vertical acetabular prosthesis, and retroversion of the acetabular and femoral components all favoured dislocation.In 331 replacements with a 22 mm diameter head 29 dislocations were seen (8.7%), whereas in 168 replacements with 32 mm heads, 5 dislocations occurred (2.9%).