Tolérance locale et cardiovasculaire d'une séance de stimulation électrique des muscles des membres inférieurs chez les patients insuffisants cardiaques

Objective: to evaluate the haemodynamic and clinical tolerance of a session of low frequency electrical stimulation of inferior limbs muscles in patients with congestive heart failure. Patients and méthods: fifteen patients with congestive heart failure were treated with a one-hour session of electrical stimulation of quadriceps and calf muscles (10 Hz frequency, maximal amplitude tolerated, alternative 20 seconds on and off). The cardiac output, the heart rate, the blood pressure and the blood velocity in the femoral artery were evaluated at baseline and during stimulation. The cardiac rythm was evaluated using a 24-hour holter recording. A subjective evaluation of the quality of the induced contractions was performed. Results: electrical stimulation did not induce changes in cardiac output and rythem, in heart rate and in blood pressure. The electrical-induced contractions were of good quality in 11 patients. The mean blood velocity in femoral artery increased during stimulation (37.6% after 20 minutes, 39.6% after 35 minutes, and 41.6% after 50 minutes). Conclusion: a one-hour session of electrical stimulation of quadriceps and calf muscles with stimulation amplitudes sufficient to obtain good-quality contraction and an increase in femoral artery blood velocity does not induce rythmic or haemodynamics variations in patients with congestive heart failure.     

Les complications neurologiques des fractures du bassin. À propos d'une série de 44 cas

In a retrospective study conducted on 44 patients admitted to a rehabilitation centre over a 4-year period with the diagnosis of pelvic fracture, signs of nerve injury as a result of fracture were recorded in 16% of patients. Double vertical fractures or sacral lesions were the most common type. Eighty-five per cent of the patients presented a motor or sensitive peripheral deficit in the lower limbs, simultaneously involving several nerve roots, especially L5-S1. The authors emphasise, in the face of the delayed diagnosis (43% in their study), the interest of a systematic, early neuroperineal examination which must be repeated. If there exists a clinical disturbance, a CT scan of the pelvis, functional explorations (EMG-urodynamic examination) and a myelo CT scan should be associated.     

La posture et le contrôle postural du patient cérébrolésé vasculaire: une revue de la littérature

After a stroke, the recovery of balance may be considered a critical component of the motor behavior for achieving autonomy in activity of daily living. The balance deficiency encountered by hemiplegic patients has been extensively reviewed in this paper, from both clinical and scientific points of view. Postural control is organized to build up and update the body orientation (posture) and ensure that balance is maintained. This complex function is based on four components [82]: reference frames for organizing posture and/or movement toward given target, multisensory inputs regulating orientation and stabilization of body segments, postural reactions or anticipations for balance recovery after disturbance, postural stabilization during voluntary movements. In the light of recent works concerning hemiplegic patients, some characteristics are emerging in each of these four fields. In the present paper, special attention was given to head and trunk orientation, sitting posture, dynamic equilibrium, and retraining balance and recoverey after a cerebrovascular accident. The authors have made an attempt to clarify the causes of balance impairment in hemiplegic patients, based on the new trends in the topic.     

L''incontinence urinaire chez la femme sportive nullipare. Enquête épidémiologique. À propos de 105 cas

One hundred and five nulliparous top-level young sportswomen (average age: 21.5 years) responded to an inquiry by means of questionnaire designed to investigate a possible relationship between urinary incontinence due to effort (UIE) and sports activities. Sixty-six sportswomen (62.8%) stated having UIE, which infrequently interfered with their normal sports activities; whereas 63 (60%) declared that they were coping with UIE on a daily basis. These two types of UIE are closely related. A comparative study on a similar population of 105 non-athletic women performed in parallel with this study showed that only 38 (34%) subjects declared having urinary incontinence, confirming therefore the influence of sport practice. Using the χ² and student's t-test, we investigated a relationship between UIE and different factors (age, duration of physical exercise, duration and type of sport practised, abdominal exercises, presence of acuneresis in children, presence of constipation). Only the presence of enuresis in children together with the presence of constipation led to statistically significant relationship. Being frustrated by taboos and considering the troubles as pathological, only a few sportswomen talked openly about this problem. Both information and effective control of the perineum could help prevent this condition. © 1998 Elsevier, Paris     

La mesure d'indépendance fonctionnelle (MIF) a-t-elle une valeur prédictive dans les accidents vasculaires cérébraux?

Objective: Assessment of the predictive value of functional independence measure (FIM) for hemiplegie patients after ischemic stroke. Method: Comparison between functional status at admittance and at discharge, this status being assessed by FIM. Population: From 11/01/92 to 04/30/93, 172 hemiplegic patients, admitted after ischemic brain lesion (30 to 94 years old, mean 72; 92 male and 80 female), were included in this study. Motor and/or cognitive deficit had been regressive for 51 patients (29.8%). Lesion was hemispheric in 119 cases: 54% right, 45% left. Results: Total regressive deficits were associated with the highest admittance FIM (a-FIM) and discharge FIM (d-FIM), 100 and 114 respectively. For partially regressive deficits with sequelae, the benefit was 22, and for the most severe deficit, it was only 4. Hemispheric lesions had lower a-FIM and d-FIM than non-hemispheric brain lesions, and benefit was lower. If right hemiplegic patients had lower scores than left, it was due to aphasia, and benefit was not significantly different between these two groups. Discussion: FIM appears to be a good indicator for discharge status, but successful discharge to home is very unprobable when a-FIM is close to 40. Correlation between FIM and the real load of nursing would have to be evaluated.     

Traitement chirurgical du pied varus équin spastique par transferts et allongements tendineux Étude rétrospective de 65 pieds opérés

The authors evaluate the efficiency of the surgical technique of split anterior tibialis transfer, describe the long-term functional results of the operation, and discuss the indications of this method of treatment. The results were very satisfactory: after surgery, 51 of 56 patients had normal shoes, 48 patients had improvement of their level of autonomy. The morbidity was very low, no patient had aggravation of the neurologic disease or general complications. The authors conclude that this operation should be employed more frequently in these disabled patients who can find definite improvement.     

Les syndromes des loges chroniques des avant-bras

The chronic non-traumatic compartinent syndrome of the forearms cire quite rare. They are caracterized by an increase of the intramuscular pressure in a closed compartment disturbing the function of the tissues. They correspond to a temporary and reversible manifestations of intramuscular pressure increases due to hyperusing, and are mainly observed in some sport activities: motocyclism, climbing, windsurf, motocross…     

La fracture de Tillaux chez l’enfant et l’adolescent. À propos d’une série de 11 cas

Background

Tillaux fracture in child correspond to Salter and Harris type III fracture involving the anterolateral portion of the distal tibial epiphysis. These are intra-articular fracture. The aim of this study was to analyze the therapeutic modalities and long-term clinical and radiological outcome.

Patients and methods

We reviewed retrospectively 11 Tillaux fractures. All underwent surgical treatment.

Results

The average age was 13.5 years. Patients were treated by open reduction and screw fixation. At mean follow-up of 28 months, results were rated well in nine of 11 cases.

Conclusion

The prognosis of Tillaux fracture in child is good as was observed in our studies and in series reported in the literature.     

Évaluation médico-économique du baclofène intrathécal chez les patients présentant une spasticité chronique sévère

A medicoeconomic evaluation of continuous intrathecal baclofen (Lioresal^®) infusion for symptomatic treatment of severe spinal spasticity was realised using a monocentric, comparative, retrospective approach where subjects were their own controls (n = 22). Study results confirm the efficacy of baclofen on symptoms, functional status of patients and on a non specific quality of life scale. Conversely, use of baclofen lead to a 67% increase of average annual costs of care for these patients and reaches around 173,500 French francs (~29,000 US$)/year. Such a cost seems to be acceptable with respect to clinical benefits. © 1998 Elsevier, Paris     

Le réentraînement proprioceptif chez les patients opérés d’une ligamentoplastie du LCA : quels effets sur le contrôle de l’équilibre ?

In order to show the effects of proprioceptive rehabilitation on postural control, 14 patients with postoperative anterior cruciate ligament reconstruction have been tested according to one-leg and two-leg standing tasks. Patients have been tested before and after the proprioceptive protocol on a force platform for three trials lasting 32 seconds, without shoes, eyes open. They were required to stay motionless as much as possible during the test. The data were then analyzed through classical parameters including mean positions, surface, variances and mean velocity of the center of pressure displacements and modeled as fractional Brownian motion (fBm). No statistically significant effect was observed during one-leg standing, whereas significant effects were reported during two-leg standing. More precisely, the strategies used to limit the antero-posterior body motions are changed and the asymmetries between the two legs, initially observed, tended to disappear. Thus, the proprioceptive rehabilitation protocol interferes with postural control, but in different ways according to the condition. Two-leg standing appears therefore as a more objective way to assess the proprioceptive rehabilitation effects and its measure may be used as benchmarks during rehabilitation.     

Troubles optomoteurs de l''ancien prématuré. Résultats du traitement au long cours à propos de 45 enfants

Twenty-three children among 45, prematurely born and with difficulties in learning to walk, with no significant intellectual impairment, were able to walk at a functional speed at the end of a period of ocular rehabilitation. The persistance of the results after some months was observed in nine cases, which seemed to depend on the quality of the initial results.     

La prévention des chutes: évaluation de l''équilibre avec stabilométrie et tests posturaux chez les patients hémiplégiques

Posture and balance have been studied in 50 hemiplegic patients according to Berg and Tinetti scales and stabilometry. There is a good correlation between the Berg and Tinetti scales when they are the highest, assessing a quite sufficient motor recovery. The same correlations are found between these scales and the results of stabilometry.     

Essai d''évaluation de l''alexie spatiale après cérébrolésion vasculaire hémisphérique droite

This paper repons the findings of a pilot study that estimated the prevalence and the characteristics of spatial alexia after a vascular lesion of the right hemisphere. The reading tests included reading of words and pseudowords, numbers, letters, numeral, and text. Errors in reading tasks were noted for 57% within the 35 patients who were examined at 50 days post stroke onset (18 showing neglect and 17 without neglect). The severity of spatial alexia was strongly related to the intensity of neglect. High-frequency and / or short words were read with greater accuracy than low frequency or long words. Performances were also better with words than with pronounceable nonwords. The majority of errors in single-words were substitutions in which overall word length was roughly preserved. This set of data emphasizes the need of a specific assessment and rehabilitation of spatial alexia after a right cerebrovascular accident.     

Fractures simultanées de la base et du col du cinquième métacarpien. À propos d’une association lésionnelle rare

We report the case of a rare combination of a fracture-dislocation of the base and a neck fracture of the 5th metacarpal, the mechanism was direct, result of a punch in a young sportsman. We made a closed reduction of both fractures with a pinning of the neck of the fifth metacarpal in L according to Vives, and intermetacarpal plinning of the base. Evolution over 12 months was satisfactory.     

Rôle de l’équipe paramédicale dans la réalisation du contrôle ciblé de la température après un arrêt cardiaque récupéré

Therapeutic hypothermia, also called targeted temperature management, is increasingly used in the intensive care unit (ICU), based on its assessed neuroprotective effects against ischemia-reperfusion-induced brain damage. Targeted temperature management is indicated in comatose adult patients after cardiac arrest if successfully resuscitated from a witnessed out-of-hospital cardiac arrest of presumed cardiac cause with an initial rhythm of ventricular fibrillation or non-perfusing ventricular tachycardia and in a stable hemodynamic condition. Patients after in-hospital cardiac arrest or with other initial rhythms may also benefit. When indicated, therapeutic hypothermia should be quickly performed and tightly controlled. Both surface and core cooling methods target a body temperature of 32 to 34 °C. Thus, it is mandatory to know how to simply manage the routinely available techniques in order to perform hypopthermia as soon as possible, being aware of all side-effects that may alter the expected benefits. Therefore, implementing hypothermia in the ICU involve the whole medical and paramedical staff.     

Influence du type d’orthèse de genou sur l’évolution clinique postopératoire d’une chirurgie du ligament croisé antérieur chez le sportif

Objectives

To establish the influence of the type of brace on the postoperative clinical evolution after anterior cruciate ligament (ACL) surgery in competitive sportspeople.

Methods

The authors prospectively followed the evolution of three populations of ACL reconstruction: one who received a functional brace, the other a rigid brace and last no brace. The three groups followed the same rehabilitation program. The clinical parameters of evaluation were pain, perimeter patellar joint, range of motion, muscular atrophy, locking the quadriceps, and the quality of walking. We also used the IKDC subjective Knee Evaluation Form and PPLP scoring scale.

Results

There is no clinically significant difference at about a month of surgery between the three groups (407 patients). There is no difference with the PPLP scoring scale. No repeat rupture is occurred postoperatively. There is a significant difference in the IKDC subjective (P = 0.03) between the group with functional brace and rigid brace.

Conclusion

With the same active rehabilitation program, the clinical evolution is identical with or without brace. The only difference is subjective (IKDC subjective Knee Evaluation Form).     

Hémiplégie et dysphagie

Eighty-three patients after unilateral stroke were investigated for swallowing disorders. They had some pharyngeal motricity alterations. All of them had water aspirations when swallowing, due to a delay of the pharyngolaryngeal deglutition. These aspirations occured before deglutition and sometimes made tracheal penetration. They were not systematically detected and expectorated by cough. For some patients, the strength of propulsion by tongue and pharynx was incomplete or weak. It provoked a vallecular and piriform stasis after swallowing.