Évaluation de la reproductibilité et de la validité de construit d’une forme modifiée de l’indice algofonctionnel de Lequesne dans l’arthrose du genouAssessment of the test-retest reliability and construct validity of a modified Lequesne index in knee osteo-arthritis

Objectives. – To assess the test-retest reliability and the construct validity of a modified version of the Lequesne index.Methods. – Patients with symptomatic knee osteo-arthritis fulfilling the revised criteria of the american college of rheumatology completed the Lequesne index twice at a 3 h interval. Impairment outcome measures and patients’ perceived discomfort in walking and handicap were recorded. An item by item analysis was performed. Items having insufficient psychometric properties were excluded. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using Spearman rank correlation coefficient and a factor analysis was performed.Results. – Eighty-eight patients were included. One question assessing pain (question IE) had a weak reliability (Kappa = 0.39) and was excluded. The test-retest reliability of the modified questionnaire was excellent (ICC = 0.95). Expected convergent and divergent correlations were achieved excepted for Vas pain and Vas handicap (0.46 and 0.40 respectively), and the “a priori” double stratification was confirmed by factor analysis, explaining 48.7% of the variance.Conclusion. – The modified form of the Lequesne index has sufficient psychometric properties to be used to assess pain and function in knee osteo-arthritis in a french population.     

Influence de l''hémofiltration artérioveineuse sur l''élimination de la teicoplanine

Objective

To assess the pharmacokinetics of a single dose of teicoplanin in critically ill patients treated with continuous arteriovenous haemofiltration (CAVH).

Study design

Prospective open clinical study.

Patients

Eleven patients with acute renal insufficiency and suspected of a Gram negative infection.

Method

After injection of teicoplanin, 6 mg·kg⁻¹ over 30 minu- tes, the plasma and haemofiltrate concentrations were measured over 24 hours with high power liquid chomatography (HPLC).

Results

In plasma, the mean half-life of the first phase was 0.6 ± 0.2 hour and terminal half-life was 16.4 ± 5.8 hours, total clearance 30.4 ± 7.1 mL·h⁻¹·kg⁻¹, volume of distribution was 0.7 ±0.3 L·kg⁻¹ and the mean resident time 19.2 ± 7.4 hours. In the hemofiltrate, the amount of teicoplanin eliminated after 24 hours was less than 1 % in seven patients, between 1.8 and 3.7% in three and reached 7% in one patient.

Conclusion

During CAVH, the elimination of a single dose of teicoplanin in the haemofiltrate is low.     

Choc anaphylactique au cours de la grossesse à terme. À propos de deux cas et revue de la littérature

Anaphylaxis is a relative uncommon event in pregnancy that can have serious implications for both mother and foetus. Two cases of grade 3 anaphylactic shock occurring at the end of the third trimester of pregnancy are reported; the causal agents were respectively amoxicilline and suxamethonium. Maternal and foetal outcome was good after adequate resuscitation and caesarean section performed in both cases because of severe bradycardia. A review of the literature confirms the good maternel outcome; neurologic damage in the newborn is frequent. On the basis of physiologic findings degranulation of placental mast cell is evoked in the genesis of birth asphyxia.     

Fracture apparemment spontanée de la pointe de l’omoplate. Rôle possible de la toux

We report a case of a fracture of the inferior angle of the scapula related to prolonged cough, without triggering trauma, sport or occupational activity. Bone insufficiency was present in this patient. Stress fractures of the scapula are rare; the fatigue type is the most frequent, associated with sports or occupational activity. We don’t find any published case report about scapula stress fracture related to cough, until rib fractures are frequent in this situation. Repetitive muscular activity of the serratus anterior and major rhomboid on the inferior angle of the scapula during cough may explain this avulsion fracture.     

Évaluation isocinétique du genou chez les patients atteints de polyarthrite rhumatoïdeIsokinetic evaluation of the knee in patients with rheumatoid arthritis.

Objectives. Rheumatoid arthritis is a chronic inflammatory disease with a clinical picture of arthritis, muscle hypotrophy, loss of range of motion, loss of strength and disability. The objective of this study was to evaluate knees of patients with rheumatoid arthritis using an isokinetic dynamometer. Methods. Fifty patients with a diagnosis of rheumatoid arthritis and 50 control subjects were evaluated using an isokinetic dynamometer (Cybex 6.000) regarding the following parameters: peak torque, peak torque angle, power, total work, peak torque acceleration time, set total work, torque acceleration energy (‘explosion’) and endurance. Comparisons between rheumatoid arthritis and the control group, left side versus right side, flexors and extensors and the proportion between flexors and extensors were made. The subjects were also evaluated through the Health Assessment Questionnaire, visual and analogical scale of pain, EPM-ROM and goniometry of the knee. Results. The results showed that patients with rheumatoid arthritis have less strength than the control group (P < 0,05); the extensors are stronger than the flexors (P < 0,05); no significant differences between the right and the left knee for rheumatoid arthritis and the control group were observed and the proportion between flexors and extensors is the same in both groups. We concluded that regarding the isokinetic parameters, the knees of subjects with rheumatoid arthritis are different from normal knees with decreased strength parameters, maintaining the proportion between flexors and extensors with a global loss of strength in the segment, excluding the high speeds in some of the parameters.