La reconstruction du ligament croisé antérieur aux tendons ischiojambiers chez les sportifs de haut niveau. Étude prospective de 30 cas

Introduction

Anterior cruciate ligament (ACL) reconstruction using hamstring graft under arthroscopy makes it possible to restore the stability of the knee allowing an early resumption of the sport. Our study aims to determine in the high level sportsmen; clinical, organic and therapeutic characteristics through the revision of a clinical series, analyzed about literature.

Material and methods

It is about a prospective Moroccan study of 30 high-level sportsmen having profited from an ACL ligamentoplasty under arthroscopy. All the patients were re-examined with three years the average retreat. Our patients was level 7 of Tegner and 30% of them were professional footballers. The therapeutic time was three years on average. The intervention proceeded under arthroscopy using hamstring graft, the fixation was ensured by screw in femur and another screw associated with staples with barbs in tibia. The protocol of rehabilitation early and was adapted to the practiced sport.

Results

The average follow up was three years. According to the quotation of Lysholm, we noted 86% from goods and excellent results, 10% of average results and 4% of bad results. According to objective score of International Knee Documentation Committee (IKDC), we noted 43% of classified patients rank A, 51% of rank B, and 6% of rank C. To the KT-1000, average differential laxity was of 1.8 mm. The average time of resumption of the competition was six months.

Discussion

The use of hamstring graft for the petitioning high level sportsman salary of an early recovery, gave us satisfaction in spite of residual laxity. In our study, the average time of resumption of the competition was six months. These results are encouraging compared to the remainder of the studies published where the resumption of the competition is recommended between sixth and the tenth month, some is the transplant used.     

Influence de l’anesthésie locorégionale sur la récupération musculaire après ligamentoplastie du genou

Anesthetic agents used for motor blocks have local toxic effects, demonstrated in vitro and in animal models. Little work has been done on the clinical impact of this toxicity. In a context of physical medicine and sports medicine, we examined several patients who had undergone knee ligamentoplasty for tears of the anterior cruciate ligament (ACL). For these patients, functional recovery was correlated with recovery of quadriceps strength. The purpose of this study was to analyze the impact of peripheral nerve blocks on quadriceps recovery at 5.5 months after knee ligamentoplasty.

Patients and methods

We conducted a retrospective analysis of 69 patients divided into three groups: 33 who had had no locoregional anesthesia (NB), 24 had femoral nerve block (FNB) and 12 had an iliofascial block (IFB). Our main outcome criterion was relative loss of quadriceps muscle force compared with the healthy side using isokinetic measures five to six months after ligamentoplasty. Isokinetic parameters were concentric Moment of Force Maximum (MFM) measured at 60°/s and 240°/s.

Results

Loss of concentric force at 60°/s was, on average: 24.7 ± 14.8% in group NB, 17.2 ± 13.9% in group FNB, and 19.7 ± 10.7% in group IFB. The difference between the three groups was not significant (P = 0.208). At rapid speed (240°/s) the deficit was on average: 23.111% in the group NB, 14.4 ± 10.5 in the group FNB and 13.4 ± 11% in the group FNB. The difference was significant only between NB and the two other groups, FNB and IFB. The quadriceps deficit was significantly greater in the patients who did not have a nerve block.

Discussion

Surprisingly, this study demonstrated result contradicting the initial hypothesis. Our finding showed that the local toxicity of anesthetic blocks did not have a negative clinical impact on muscle force, but that there was a positive effect on the quality of quadriceps recovery during the time studied. The conclusions of this retrospective preliminary study, with the resulting methodological limitations, must be re-evaluated with other work.     

Hospitalisation en court séjour pour reconstruction du ligament croisé antérieur : étude prospective comparative

Introduction

In France, the median duration of hospitalization for a reconstruction of the anterior cruciate ligament (ACL) is 3 days. The purpose of this study was to evaluate the feasibility and acceptability of hospitalization for one day for this surgery.

Patients and methods

A prospective study conducted in 2011 included patients who underwent surgery for an ACL rupture. Exclusion criteria were age > 60 years, scores ASA3-4 and patients unmanageable in short-stay. Two groups of patients were formed: “short-stay” with an output at D1 and “conventional hospitalization” with an output at D3. The postoperative analgesia protocol included analgesics I-II, morphine on demand during hospitalization. “Short-stay” group received a telephone follow-up (D1–D4). The primary outcome was patient satisfaction at D3. The secondary endpoints were postoperative pain assessed on a visual analogue scale at D3 and adverse events. Thirty patients were included in each group, 34 men and 26 women, mean age 29 ± 5 years.

Results

Patients in group “short-stay” were on average more satisfied than the “conventional hospitalization” group, P = 0.01. The pain was significantly less pronounced in the “short-stay” group, P = 0.00001. No complications occurred.

Conclusion

Inpatients short-stay were significantly more satisfied and less painful than those in conventional hospitalization group. Future studies should evaluate the feasibility of ambulatory surgery for ACL reconstruction.     

Test isocinétique précoce après ligamentoplastie antérieure de genou : résultats et conclusions

Objectives

To compare 4-months isokinetic results after anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons.

Material and methods

A retrospective study during 5 years concerning isokinetic records from patients who went to our rehabilitation center after anterior cruciate ligament reconstruction, and who did an isokinetic test 4 months after surgery. There was 146 patients, 116 males and 30 females, 69 with hamstring reconstruction and 77 with patellar tendon reconstruction.

Results

In Kenneth-Jones surgery, there is more deficience on leg extensors, while hamstrings are more deficient after hamstrings reconstruction surgery. This deficience concerns peak torque and work, whatever speed.

Conclusion

Leg flexion deficience in hamstring reconstruction surgery is due to late work during reeducation, because of pain and injuries localized on sample area. There is also loose of biomechanical properties due to muscular fibrosis. For the two reconstruction surgeries, leg extension deficience is due to pain and edema.     

Facteurs de risque intrinsèques de tendinopathie patellaire chez le volleyeur. Étude prospective de 29 cas

Background

Patellar tendinopathy is a common and disabling injury among athletes, especially in sports with jumps such as volleyball.

Objective

The aim of this study was to determine intrinsic risk factors of patellar tendinopathy among young volleyball players.

Methods

This prospective study was conducted from August 2012 to April 2013. It included a clinical examination, ultrasound, muscle isokinetic assessment and tests of jumps at the beginning of the season, and then only a clinical examination at the end of the season. Athletes who developed patellar tendinopathy were compared to healthy subjects.

Results

Patellar tendinopathy (PT) group athletes (6) were older (17.2 ± 0.4 years vs 16.2 ± 0.9 years, P = 0.02) and had a stiffness of hamstrings higher (popliteal angle of 24 ± 12° vs 14 ± 9°, P = 0.04) than healthy athletes (16). They had an eccentric quadriceps peak torque at slow speed (30°/s) lower than healthy athletes (2.7 ± 0.2 Nm/kg vs 3.2 ± 0.5 Nm/kg, P = 0.05).

Conclusion

Age, stiffness of hamstrings and an eccentric strength deficit of quadriceps at slow speed (30°/s) would be intrinsic risk factors of PT among young volleyball players.     

Change of impairment, disability and patient satisfaction after total knee arthroplasty in secondary care practice

Objectives

To assess the evolution of impairment and disability after total knee arthroplasty (TKA) for osteoarthritis and to seek an association with patient satisfaction with surgery.

Method

Consecutives patients (n = 45, 18 women) with osteoarthritis undergoing primary TKA in two secondary care inpatient clinics were prospectively assessed before one month and six months after surgery. Disability was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-900) and the Lequesne Index (range 1-24). Patients’ perceived handicap was assessed on a visual analog scale (VAS, range 1-100). At one month and six months postoperatively, kinetic strength of quadriceps and hamstrings was obtained by isokinetics measures and patient satisfaction on a VAS (range 1-100).

Results

Mean age was 71.7 ± 7.0 years; mean duration of symptoms was 38.3 ± 33.4 months. Patient satisfaction was 83.9 ± 17.7 and 83.1 ± 22.4 at one month and six months after TKA, respectively. At one month, significant improvements were observed over baseline for pain (−30.73 ± 32.2; p < 0.01), physical function (Lequesne Index −2.28 ± 3.6, p < 0.01; and WOMAC score, −82.60 ± 148.5, p < 0.01), and patient perceived handicap (−21.84 ± 29.6, p < 0.01). A significant decrease in global knee range of motion was also observed. At six months, significant improvement was observed for pain (−47.96 ± 26.8; p < 0.01), physical function (Lequesne Index, −5.08 ± 3.66, p < 0.01; and WOMAC score, −157.04 ± 153.2, p < 0.01) and patient perceived handicap (−39.60 ± 24.1; p < 0.01). All isokinetics measures for quadriceps and hamstring were significantly improved between one month and six months after surgery. At one month and six months, the correlation between patient satisfaction and change in impairment, disability and patient perceived handicap was weak.

Discussion and conclusion

Impairment, disability and patient perceived handicap improved significantly after TKA for osteoarthritis. However, these improvements were poorly correlated with patient overall satisfaction with surgery.     

Traitement de la laxité latérale de cheville par ligamentoplastie à l’hémitendon du court fibulaire avec remise en tension capsuloligamentaire

The authors developed an original method, using tenodesis and anatomical repair, for the treatment of lateral chronic instability of the ankle in young military people. In this medium-term retrospective study, 32 patients were rewieved for functional and radiological evaluation. With a mean follow-up period of 20 months (range from six to 64 months), 90.6% (n = 29) of the patients were “satisfied” or “very satisfied”, 78.1% (n = 25) were painfree, but 15,6% (n = 5) complained about stiffness. Ninety-seven percent of them (n = 31) returned to athletic activity and no instability occured. The mean score for the Olerud and Molander Ankle Score was 91.5 (range from 70 to 100). On postoperative stress radiographs the mean side-to-side talar tilt difference was 0.6 ± 2.9°. The mean loosening of eversion isometric strength on the ankle operated was 5.4%. The present study demonstrates that this mixed procedure give excellent results in terms of stability, despite of a well-tolerated stiffness.     

La rééducation d'emblée des ischiojambiers après chirurgie du DIDT

Introduction

Following knee ligamentoplasty, the task of muscle restoration principally focuses on the hamstrings, which are the only active structure which can protect the graft and prevent detachment. However, specialists generally advise against work on these muscles for a period of 3–6 weeks following semi-tendinosus and gracilis surgery. The hamstrings are thus left resting during this period, which encourages their wasting and tightening.

Objective

Our team, guided by the principles of rehabilitation for muscular problems, has for more than 2 years been strengthening the hamstrings immediately following ligamentoplasty surgery, making use of the semi-tendinous and gracilis. The objective is not only muscle performance and the protection of the graft, but above all encouraging the healing of the semi-tendinous and gracilis in order to align the collagen fibres and improve their mechanical resistance.

Content

It is a single-focus study, continually rolled forward. This protocol was practised on 56 patients, two patients having to withdraw from the programme because of strain problems.

Methodology

During the hospitalisation of the patient, concentric contraction of the knee flexors was engendered using weak resistance operated manually. Later in our rehabilitation centre, our patients exercised in a hamstring « chair », in the eccentric mode below maximum charge, with an increasing load progression. This was done daily up to the sixth week.

Results

Our results, at the 3rd and 6th week post-surgery, showed a favourable change in articular amplitude and pain suffered, with a low rate of complications. Evidence of pain was found in 12.5% of cases (7/56). Of these 7 patients, 2 (3.5%) had incidents involving muscular strain, rendering the interruption of the physiotherapy necessary for more than 3 consecutive days. Isokinetic results carried out at 4.6 ± 0.7 months showed excellent muscular recuperation of the hamstrings with a deficit of 9.6 ± 14% at slow speed and of 6.8 ± 13.1% at fast speed compared with the heterolateral side.

Discussion

The number of painful occurrences in our study, at 12.5%, is lower than the 20% ad higher frequently found in other documented cases. However the definition of these painful occurrences is imprecise. The performance deficit of hamstrings measured by isokinetic tests after 6 months varied between 15 and 20% depending upon the published study. In our study the results at 4.6 months were better (< 10%).

Conclusion

There can no longer be any doubt about the benefits of strengthening the hamstrings in pathologies of an anterior cruciate ligament. Our work has shown that the early strengthening of these muscles is not disadvantageous. On the contrary we believe that our policy promotes the patient's muscular and functional recovery.     

Lésions isolées du ménisque latéral sur genou stable opérées : étude fonctionnelle à 10 ans de suivi

Meniscals lesions are frequent during sport practice. Although lateral meniscus is affected in only 25% of all meniscus lesions, lateral lesions are usually known to have a poor clinical outcome. Our monocentric study consisted in a systematic evaluation of all patients treated in our unit for a unique lesion of the lateral meniscus in an otherwise normal knee. Follow-up was at least of ten years. Functional results were rated with four cotations currently used in traumatologic practice. A statistic analysis was made to identify predictive factors of poor outcome. Thirty-nine patients have been included. Functional evaluation showed 12% of excellent, 41% of good, 35% of medium and 12% of bad results with Arpege score, 65% of good and very good and 35% of medium results with Lysholm score. The average subjective IKDC score was 58 ± 15, objective IKDC cotation found 0% of A, 88% of B and 12% of C. The average Koos score was 83.7 ± 17. Better evolution was found for patients with horizontal lesions (P = 0.04) or patients with central segment injury (P = 0.05). Similar data concerning the poor functional outcome of lateral meniscus tears has been published. Only two thirds of patients have good or excellent results after 10 years.     

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction

Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities.

Patients and methods

It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive.

Results

This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level.

Discussion

The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.     

Thyroid blood flow as a useful predictor of relapse of Graves’ disease after normal delivery in patients with Graves’ disease

Objective

Measurement of the peak systolic velocity (PSV) in the inferior thyroid artery (ITA) before withdrawal of an anti-thyroid drug (ATD) is useful for predicting relapse of Graves’ disease (GD). We further investigated whether the ITA–PSV can be used for prediction of GD relapse after delivery in euthyroid women with GD who stopped ATD administration during mid- to late pregnancy.

Patients and methods

ITA–PSV was monitored monthly for three months after delivery in 42 women with GD aged from 24 to 45 years old (mean ± SE: 34.7 ± 0.92 years old) who met the above criteria. To confirm the stability of the measurement, ITA–PSV was also measured monthly in 32 age-matched non-pregnant normal women and for three months after delivery in 10 age-matched women.

Results

ITA–PSV and thyroid volume were higher in women with GD immediately after delivery compared to normal women, but the levels of TSH receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) did not differ significantly between the two groups. Of the 42 patients, 23 had relapse of GD and the smoker/non-smoker ratio and thyroid volume in these patients immediately after delivery were significantly higher than those in the 19 patients who did not undergo relapse (10/23 vs. 0/19, p < 0.0001; 24280.3 ± 2280.9 vs. 19670.0 ± 2103.7 mm³, p = 0.046), while ITA–PSV, TRAb and TSAb did not differ between the two groups of patients. The ITA–PSV ratio was calculated by dividing each value in the follow-up period by that obtained immediately after delivery. A significant increase in the mean ITA–PSV ratio occurred at least one month before the time of relapse (1.00 ± 0.00 at –3 months before relapse vs. 1.46 ± 0.12 at –1 month, p = 0.010; 1.00 ± 0.00 at –3 months vs. 1.77 ± 0.13 at the time of relapse, p = 0.0048). In contrast, there were no significant changes in this ratio during the follow-up period in non-relapse patients.

Conclusion

Monthly measurement of ITA–PSV after delivery in remitted euthyroid women with GD may assist in early prediction of GD relapse.     

Influence of pre-course assessment using an emotionally activating stimulus with feedback: a pilot study in teaching Basic Life Support

Background

Cardiopulmonary resuscitation (CPR) mastery continues to challenge medical professionals. The purpose of this study was to determine if an emotional stimulus in combination with peer or expert feedback during pre-course assessment effects future performance in a single rescuer simulated cardiac arrest.

Methods

First-year medical students (n = 218) without previous medical knowledge were randomly assigned to one of the study groups and asked to take part in a pre-course assessment: Group 1: after applying an emotionally activating stimulus an expert (instructor) gave feedback on CPR performance (Ex). Group 2: after applying the same stimulus feedback was provided by a peer from the same group (Pe); Group 3: standard without feedback (S). Following pre-course assessment, all subjects received a standardized BLS-course, were tested after 1 week and 6 months later using single-rescuer-scenario, and were surveyed using standardized questionnaires (6-point-likert-scales: 1 = completely agree, 6 = completely disagree).

Results

Participants exposed to stimulus demonstrated superior performance concerning compression depth after 6 months independent of feedback-method (Ex: 65.85% [p = 0.0003]; Pe: 57.50% [p = 0.0076] vs. 21.43%). The expert- more than the peer-group was emotionally more activated in initial testing, Ex: 3.26 ± 1.35 [p ≤ 0.0001]; Pe: 3.73 ± 1.53 [p = 0.0319]; S: 4.25 ± 1.37) and more inspired to think about CPR (Ex: 2.03 ± 1.37 [p = 0.0119]; Pe: 2.07 ± 1.14 [p = 0.0204]; S: 2.60 ± 1.55). After 6 months this activation effect was still detectable in the expert-group (p = 0.0114).

Conclusions

The emotional stimulus approach to BLS-training seems to impact the ability to provide adequate compression depth up to 6 months after training. Furthermore, pre-course assessment helped to keep the participants involved beyond initial training.     

Pushing harder,pushing faster,minimizing interruptions… But falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation

Aim

The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve.

Methods

Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines. CPR recording/feedback-enabled defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF, %), leaning (% > 2.5 kg)). Audiovisual feedback for depth was: 2005, ≥38 mm; 2010, ≥50 mm; for rate: 2005, ≥90 and ≤120 CC/min; 2010, ≥100 and ≤120 CC/min. The primary outcome was average event depth compared with Student's t-test.

Results

45 CPR events (25 before; 20 after) occurred, resulting in 1336 thirty-second epochs (909 before; 427 after). Compared to 2005, average event depth (50 ± 13 mm vs. 43 ± 9 mm; p = 0.047), rate (113 ± 11 CC/min vs. 104 ± 8 CC/min; p < 0.01), and CCF (0.94 [0.93, 0.96] vs. 0.9 [0.85, 0.94]; p = 0.013) increased during 2010. CPR epochs during the 2010 period more likely to meet Guidelines for CCF (OR 1.7; CI95: 1.2–2.4; p < 0.01), but less likely for rate (OR 0.23; CI95: 0.12–0.44; p < 0.01), and depth (OR 0.31; CI95: 0.12–0.86; p = 0.024).

Conclusions

Institution of the 2010 Guidelines was associated with increased CC depth, rate, and CC fraction; yet, achieving 2010 targets for rate and depth was difficult.     

Fonction et niveau d’activité physique deux à cinq ans après la reconstruction du ligament croisé antérieur (LCA)

Objectives

Evaluation of functionality and level of physical activity in patients 2 to 5 years after anterior cruciate ligament reconstruction.

Material and methods

A nonrandomized study, which included consecutive patients (n = 31) who underwent ACL reconstruction and were evaluated 2-5 years after ligament reconstruction. The surgical techniques used were the bone-patellar tendon-bone graft (BTB), quadriceps tendon (QT) and semitendinosus gracilis tendons (ST-G). The clinical evaluation included the Tegner activity Index (TI), Lysholm Index (LI), Index Knee Outcome Survey (KOS) in their sub-divisions “Total”, “Activities of Daily Living” and “Functionality” (KOS-T, KOS-ADL, KOS-IF) and Noyes Test (NT). The Package for Social Sciences (SPSS) version 17.0 for Windows was used for the statistical study.

Results

Before injury, the TI was 6.74 and after injury 4.35; the LI average was 89.55; the KOS-T was 70.48, KOS-ADL 30.48 and KOS-FI 39.95; and the NT gave a symmetry score of 96.6%. No significant correlations were found between the values of the TI before and after injury, or between the values of the LI and KOS-ADL, and the LI and NT.

Conclusion

ACL injury is associated with a high number of meniscal and chondral injuries, with direct impact on the prognosis of these patients’ sport activity and a reduction in activity levels. This reduction is not accompanied by a significant functional loss and normal daily activities are unaffected. The motivation of the patient and medical advice are considered key factors in promoting recovery to the pre-lesional level.     

Hernie discale,microchirurgie et sport. De la rééducation au retour sur le terrain

Background

Microdiscectomy of lumbar disc herniation changed rehabilitation after lumbar disc surgery of athletes.

Hypothesis

Returning to a high activity level after microdiscectomy for athletes versus possible with a well-conducted rehabilitation and athlete training.

Methods

Thirty-three athletes (29 males and four females with a mean age of 30.8 years, range: 20–49 years) were identified in Centre européen de rééducation du sportif (CERS) during 2007–2008 after lumbar disc microdiscectomy. By phone, 31 answered a Oswestry's low back pain disability questionnaire, a Prolo's questionnaire, gave the delays of training's resumption, of competition return and the importance of residual pain with numeric verbal scale (0 to 10).

Results

At the time of the inquiry, the average post-surgery delay was 768 days (from 405 at 1642 days). The mean Oswestry's disability questionnaire was 6.5 (range: 0–32) and the median sum of Prolo's scales was 8.9 (range: 3–10). Forty-three percent of athletes have pain estimated at 4. On a scale from 0 to 10, mean score of functional abilities was 8.6. Seventy-seven percent of athletes returned jogging 4.9 months (range: 1.5–10 months), 81% returned training 6.5 months and 52% athletes came back competition at 8.2 months with 33% returned to sport on previous level.

Discussion and conclusion

The authors discuss the literature's data and conclude that the rehabilitation must be early, heavy, long until return on the field.     

Polyamine reduced diet (PRD) nutrition therapy in hormone refractory prostate cancer patients

Background

Reducing polyamine uptake by selecting low polyamine-containing foodstuffs and reducing bacterial gut production can improve performance status and pain control in hormone refractory prostate cancer (HRPC) patients. Long term PRD observance and tolerance were assessed. Cancer specific survival was studied in function of PRD and time of PRD initiation.

Methods

Twenty-six volunteers, age: 68 ± 10 years with metastatic HRPC accepted a polyamine reduced diet and partial gut decontamination with oral neomycin or nifuroxazide (750 mg daily, one week out of two). Time from HRPC to PRD initiation was 10 ± 8 months. WHO performance status, EORTC pain scale, body weight, blood counts and serum proteins were regularly assessed. Sixteen other HRPC patients eating a normal diet served as “controls”.

Results

Mean diet observance is 25 ± 24 months. Tolerance is good. WHO performance status and EORTC pain scales were significantly improved respectively at 3 months (0.5 ± 0.7 vs 0.7 ± 0.9: p = 0.03) and 6 months (0.5 ± 0.8 vs 1 ± 1.3, p = 0.02) compared to initial values. Median cancer specific survival times after HRPC and PRD initiation are respectively 36 and 21 months. Eleven PRD patients started the diet before a 9 months cut-off period (after HRPC) and 15 patients after. Median cancer specific survival times for these two groups of patients are respectively 44 and 34 months, p = 0.014. Median cancer specific survival times (after HRPC) for PRD patients compared to controls are 36 vs 17 months (p = 0.004).

Conclusions

Polyamine-reduced diet is well observed and tolerated. It seems to improve and/or maintain quality of life for HRPC patients. Early PRD initiation in HRPC is promising and may impact favorably cancer specific survival. These results open a rationale for PRD in HRPC management and warrant further investigation.     

Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse

Objective

Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).

Patients and methods

Forty-five obese adults, with a body mass index greater than 35 kg/m² or 30 ≤ BMI < 35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).

Results

There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26 %), diet plus exercise (G3) (37,89 %) and diet only (G4) (18,34 %). We also noticed an improvement in pain in G2 (p = 0.04), G3 (p < 0.001) and G4 (p = 0.02). The improvement of quadriceps strength was noted only in G2 (p = 0.01) et G3 (p = 0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).

Conclusion

The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.     

Évaluation isocinétique des muscles fléchisseurs et extenseurs du genou chez de jeunes footballeurs

Objective

To assess the knee muscles power using isokinetic in a population of young soccer players. To investigate the relationships between isokinetic peak torque and each player's position in the playground.

Population and methods

Thirty-eight young soccer players (mean age 14.57 years old with extremes ranging from 13 to 17 years old) underwent an isokinetic assessment on both knees on an isokinetic dynamometer Cybex-NORM™ on three angular velocities: 60 °/s, 180 °/s and 240 °/s concentric mode. The peak torque, the peak torque on the weight and the ratio of hamstring/quadriceps were noted. These athletes were divided into three groups: strikers (16), defenders (16), and goalkeepers (6).

Results

Hamstring/quadriceps ratio was at low speed 60 °/s between 72 and 74%, at medium speed (180 °/s) between 78 and 80%, and high speed (240 °/s) between 85 and 90%, the peak torque by extensor muscles weight was around 2.6 N m/kg. Overall, there was no significant difference between the three groups of players; there were no significant difference between the dominant side and the non dominant side.

Conclusion

There was no significant difference of the isokinetic peak torque between the players, no difference between agonist and antagonist muscles activity in isometric knee strength and no difference between the dominant side and the non dominant side. The isokinetic is a method for the assessment of the force and preventing muscle injuries of the knee.     

Comparison of times of intervention during pediatric CPR maneuvers using ABC and CAB sequences: A randomized trial

Background

The proposed introduction of the CAB (circulation, airway, breathing) sequence for cardiopulmonary resuscitation has raised some perplexity within the pediatric community. We designed a randomized trial intended to verify if and how much timing of intervention in pediatric cardiopulmonary resuscitation is affected by the use of the CAB vs. the ABC (airway, breathing, circulation) sequence.

Patients and methods

340 volunteers, paired into 170 two-person teams, performed 2-rescuer healthcare provider BLS with both a CAB and ABC sequence. Their performances were audio–video recorded and times of intervention in the two scenarios, cardiac and respiratory arrest, were monitored.

Results

The CAB sequence compared to ABC prompts quicker recognition of respiratory (CAB vs. ABC = 17.48 ± 2.19 vs. 19.17 ± 2.38 s; p < 0.05) or cardiac arrest (CAB vs. ABC = 17.48 ± 2.19 vs. 41.67 ± 4.95; p < 0.05) and faster start of ventilatory maneuvers (CAB vs. ABC = 19.13 ± 1.47 s vs. 22.66 ± 3.07; p < 0.05) or chest compressions (CAB vs. ABC = 19.27 ± 2.64 vs. 43.40 ± 5.036; p < 0.05).

Conclusions

Compared to ABC the CAB sequence prompts shorter time of intervention both in diagnosing respiratory or cardiac arrest and in starting ventilation or chest compression. However, this does not necessarily entail prompter resumption of spontaneous circulation and significant reduction of neurological sequelae, an issue that requires further studies.     

Early coronary revascularization improves 24 h survival and neurological function after ischemic cardiac arrest. A randomized animal study

Background

Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24 h-survival and neurological outcomes.

Methods

Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5 min, VF was induced and left untreated for 8 min. If return of spontaneous circulation (ROSC) was achieved within 15 min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45 min (group A) or 4 h (group B) of LAD occlusion. Animals without ROSC after 15 min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45 min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10 min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion.

Results

Early compared to late reperfusion improved survival (10/11 versus 4/10, p = 0.02), mean CPC (1.4 ± 0.7 versus 2.5 ± 0.6, p = 0.017), LVEF (43 ± 13 versus 32 ± 9%, p = 0.01), troponin I (37 ± 28 versus 99 ± 12, p = 0.005) and CK-MB (11 ± 4 versus 20.1 ± 5, p = 0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C.

Conclusions

Early reperfusion after ischemic cardiac arrest improved 24 h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.