Place du traitement médicamenteux et des infiltrations dans la prise en charge médicale des lésions de la coiffe des rotateurs

One of the main objectives of medical treatment of rotator cuff lesions is to attenuate or totally relieve pain and allow the patient to access the next phase of functional rehabilitation. Relative rest is desirable. Harmful sports movement should be avoided. Strict immobilization is never indicated. The question is raised as to whether wider use of analgesics would be warranted. The inflammatory nature of rotator cuff tendiopathies remains to be clearly demonstrated and the efficacy of analgesics in this indication would be related more to their intrinsic pain killer action. Analgesics should thus be prescribed prudently and limited to a few days, particularly because of the potential adverse effects. Theoretically, steroidal anti-inflammatory drugs should not be used for tendonitis. Myorelaxing agents could be used in the event of associated muscle contracture. If the patient requires further relief, corticosteroid injections could be considered, taking care to avoid contraindications for intra-articular injections and avoiding any risk of contamination while keeping in mind the possible adverse effects.     

Évaluation des pressions de remplissage ventriculaire gauche par échocardiographie-doppler

The evaluation of left ventricular (LV) filling pressures is crucial to identify a congestive heart failure in a patient presenting with an acute respiratory failure. This evaluation traditionally relies on the invasive measurement of the pulmonary artery occlusion pressure during right heart catheterization. Echocardiography Doppler is an unparalleled alternative technique to assess LV filling pressures, which also provides anatomical and functional information on the heart and great vessels. Pulsed wave Doppler of the mitral valve and pulmonary veins provides indices that are easy to measure and allow a semi-quantitative assessment of LV filling pressures. Their accuracy increases in the presence of a LV systolic dysfunction. New Doppler indices, which assess more specifically LV diastolic properties (Doppler Tissue Imaging of the mitral ring, color M-mode propagation velocity) can be combined to traditional Doppler parameters to more precisely assess LV filling pressures. In addition, echocardiography allows a comprehensive assessment of both the left and right ventricular function, the diagnosis of an underlying cardiopathy, or the identification of an acute condition of the heart or great vessels that precipitated the acute respiratory failure. Accordingly, echocardiography Doppler is a cornerstone in the evaluation of patients presenting to the intensive care unit with a respiratory failure and a high index of suspicion of pulmonary venous congestion. This imaging modality is particularly valuable for the evaluation of patients with a medical history of chronic respiratory failure and cardiac failure, to confirm or confidently rule out a cardiogenic pulmonary edema, or to identify a cardiac source of ventilator weaning failure.     

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).     

Antigènes fongiques en réanimation : tests disponibles et état des lieux

Numerous serological assays try to supply the pitfalls of microbiological diagnostic methods for fungal infections. Several antigens have been assessed: the galactomannan (GM), the mannan (Mn), the β-glucan (ßG), and the capsular antigen for the diagnosis of invasive aspergillosis, yeast infections, all the fungal infections, and the Cryptococcus neoformans infection respectively. The performance characteristics of these assays are usually satisfactory when serum samples collected in well defined clinical settings are used. In contrast, the results of prospective studies are often disappointing. This underlines the difficulty in standardizing the patient populations and the definitions of fungal infections. For the GM assay, the conclusions obtained in onco-hematology can be used for immunocompromised patients hospitalized in intensive care units. For the Mn assays, the hope relies on the simultaneous detection of both antigen and antibodies. The advantage over the microbiological screening for yeasts of different anatomical sites remains to be demonstrated. For the βG assay, its best interest seems to be its negative predictive value as bacterial and fungal infections are hardly distinguished when the test is positive. Excepted for the capsular cryptococcal antigen, a single test is usually not contributive for any of the assays, which should be implemented as a screening test for patients at risk for fungal infections.     

Muscle soléaire accessoire. À propos d'un cas et revue de la littérature

The soleus accessory muscle is an anatomical congenital variation, responsible for a soft tissue mass posteromedial to the ankle that can be source of a functional disorder while physical activity. Differents hypothesis have been proposed to explain the physiopathology of the clinical picture. Magnetic resonance imaging is the most accurate investigation to establish the diagnosis. In case of an important functional limitation, especially in athletes, surgical excision is necessary. In the following we present the case of a 15 years old athlete and a review of the literature concerning this pathological entity.