Comparison between clinical Cobb angles and measurements performed on vertebral bodies, pedicle centroids and spinous processes

GOAL: Evaluate the relations between the clinical Cobb angle measured on radiographic images and the computerized Cobb angles measured on curves passing through: 1) the vertebral body centroids, 2) the pedicle centroids and 3) the spinous process tips, in the frontal plane, the sagittal plane and the plane of maximum curvature. MATERIAL AND METHODS: A bi-planar radiographic technique was used to reconstruct in 3D the spine geometry for 39 adolescent girls having double-curved idiopathic scoliosis. The Cobb angles were measured clinically on the radiographs and were computed on the 3 curves. RESULTS: Every relation was found significant and their determination coefficient (R2) was between 0.38 and 0.98. Linear relations were established between clinical and computerized angles. Angles measured on the curve passing through the pedicle centroid correlated best with clinical indices. CONCLUSIONS: The computerized measurements of Cobb angles from 3D models can be used with confidence and are interchangeable, provided the appropriate conversion factor is used.     

Surgical repair of abdominal wall]

Surgical repair of abdominal wall defects following tumour resection only raises real problems when the nature of the tumour required wide, or even transfixing excision, as in the case of sarcomas or very advanced carcinomas. Superficial repair is performed according to the algorithm of the simplest technique: secondary healing, partial suture, total suture, transplant, or flap (pedicled or free). In the case of transfixing resection, the combination of a biomaterial for reconstruction of the deep plane and a superficial flap is necessary. For very large transfixing defects of the abdomen, a free flap may be required and, in this case, delayed insertion after initial transfer may further reduce the operative risk ("apple turnover" technique). The complications observed in a detailed series of 9 cases operated at Saint-Louis Hospital consisted of one intraoperative cardio-circulatory arrest during second-stage surgery and one late infection at three years. The authors believe that the indications for delayed insertion of a free flap are still very topical in cases in which a very large grafted free flap is necessary in conjunction with a prosthesis. Large abdominal defects after cancer resection can be reconstructed by modern reconstructive surgery.     

Fetal echocardiography during the 2nd half of pregnancy. Biometry and functional approach

Fetal cardiac biometry was conducted in the TM mode, after real time anatomical outlining of the plane of the four cardiac cavities, on 48 recordings of supposedly normal pregnancies of 23 to 39 weeks of amenorrhoea. Ten measurements were made for each patient, in an immediately subvalvular plane perpendicular to the septum (dimensions of the two ventricular cavities, of the wall of the two ventricles, and of the septum, in diastole and systole respectively). Functional results derived from this data showed that the difference between diastolic and systolic values for ventricular diameters increased with term, the ratio of the diastolic diameter of the right ventricle (RV) to that of the left ventricle (LV) was a constant: 1.23 +/- 0.12, and the size of the RV was always superior to that of the LV (+ + +). Alson noted was that percentage shortening of the LV was superior to that of the RV, and mean percentage thickenings of the RV and septum were inferior to that of the LV. A further observation was that interpretation of the kinetic of the septum requires precise knowledge of the plane of the section in relation to "the pivot point".     

Headache and family history

In two headache questionnaire surveys we inquired about the occurrence of headache in the mothers, fathers, siblings and children of the respondents. In total, 633 people completed valid questionnaires, 260 in the first survey and 373 in the second. The hypothesis was that familial headache occurrence would be positively associated with headache frequency. In each survey, the regression of headache frequency on the number of parents having headache was highly significant. Neither sex nor the sibling and children variables were significant predictors. In the cross-tabulations of the parental occurrence of headache with headache frequency we saw a clear "break-point" between the "no headache" and the headache frequency categories studied. For the final analyses the dichotomy "headache/no headache" was related in fourfold tables to headache occurrence in the father and the mother separately, and to the number of headache parents. The positive associations were not simply due to the large number of migraine cases since they remained after removing the migraineurs.     

Mechanisms of myofascial pain

The aim of this paper is to review available data and current hypotheses concerning myofascial pain syndrome pathophysiology and implications for clinical practice. A muscular hypothesis has been proposed for episodic and chronic tension headache as well as for myofascial syndrome and fibromyalgia. These different syndromes may be compared as, besides their frequent combination, they have common features characterized by spontaneous pain, painful points, and lack of objective findings. They must be distinguished because each has its own diagnostic criteria. Pressure algometry appears to be a reliable method for assessing pressure sensitivity in myofascial pain. Pressure pain is not specific to tension headache and can be observed in other chronic headaches. It has not been demonstrated that the trigger points of fibromyalgia are specific in idiopathic cases. It is difficult to find an electrophysiological investigation which is specific for myofascial pain. For daily practice, the clinical approach with interview and examination remain the advisable attitude. Pathophysiological hypotheses help in better understanding of referred pain by sensitization of nociceptive central pathways according to the Ruch convergence projection theory (1965), modified by Mense in 1994. These theories do not however provide an explanation of the primary muscular mechanisms. Implications for myofascial pain patient management is discussed.     

Semimonthly versus monthly regimen of fluorouracil and leucovorin administered for 24 or 36 weeks as adjuvant therapy in stage II and III colon cancer: results of a randomized trial.

PURPOSE: This randomized, 2 x 2 factorial study compared a semimonthly (LVFU2) with a monthly (FULV) regimen of fluorouracil and leucovorin and 24 versus 36 weeks of each regimen as adjuvant treatment of patients with stage II (Dukes' B2) and III (Dukes' C) colon cancer. PATIENTS AND METHODS: LVFU2 was administered semi-monthly for 2 consecutive days as dl- or l-leucovorin (200 or 100 mg/m2, respectively) as a 2-hour infusion, followed by a 400 mg/m2 FU bolus and 600 mg/m2 of FU as a 22-hour continuous infusion. FULV was administered monthly for 5 consecutive days as a 15-minute infusion of dl- or l-leucovorin, followed by 400 mg/m2 of FU as a 15-minute infusion. RESULTS: A total of 905 patients were randomly assigned. The median follow-up was 41 months. Disease-free survival was similar between the LVFU2 and FULV groups (127 v 124 events; hazard ratio [HR] = 1.04; P =.74) and between 24 and 36 weeks of therapy (128 v 123 events; HR = 0.94; P =.63). Analysis of overall survival showed a slight excess in the number of deaths in LVFU2 compared with FULV (73 v 59), but this difference was not statistically significant (HR = 1.26; 95% confidence interval, 0.90 to 1.78; P =.18). The most commonly observed grade 3 to 4 toxicities were neutropenia, diarrhea, and mucositis. Toxicities were significantly lower in the LVFU2 group (all toxicities, P <.001). CONCLUSION: Our data confirm that LVFU2 is less toxic than FULV. At a median follow-up of 41 months, no statistically significant difference could be detected in disease-free or overall survival between the treatment groups or treatment durations.