Cotrel-Dubousset instrumentation in the treatment of scoliosis

The authors describe the operative principles of the C.D. device reviewing implantable material (rods and hooks, screws and transverse system). The principles of this surgical approach (2 rods) which offers the possible distraction and contraction where necessary, are described. Good derotation is achieved and a strong and stable square support device enabling the patient to be got out of bed rapidly without any need for post-operative support. The post-operative care is extremely easy and a rapid return to school activity is possible.     

Présentation de la série du GECO de métastases osseuses des membres : 90 cas

This series of surgical patients shows that 50% of bony metastases are complicated by a fracture. Of these, 50% occurred without any preceding symptoms or signs.     

Electro-drug anesthesia. Clinical and hormonal effects of transcranial electrostimulation

The French technique of anaesthesia by electrostimulation described in 1972 by Cara and coworkers, consists of transcranial electrostimulation by means of a high frequency current combined with administration of a neuroleptic drug, a benzodiazepine, a curare and nitrous oxide with oxygen. Fentanyl is also given by some authors. In order to assess the benefit of such electrostimulation, this study compared two randomized groups of ten patients, scheduled for abdominal and pelvic surgery. Both groups received the same drugs (i.e. droperidol, flunitrazepam, pancuronium and nitrous oxide with oxygen), whereas patients in group I were also submitted to electrostimulation. This study describes and discusses the clinical behaviour of patients and the hormonal reactions before, during and after surgery. In both groups, operative conditions were satisfactory. Recovery and onset of spontaneous ventilation were rapid and no patient had an unpleasant recall of the operation itself. However, most of them complained of postoperative pain. Electrostimulation did not reduce the quantity of drugs required during and after surgery. In both groups, circulatory activity was significantly increased. In group I, the arterial pressure and the heart rate were significantly higher than in group II during and after surgery. The hormonal reactions showed that in both groups adrenocorticotrophic hormone, growth hormone and antidiuretic hormone increased during surgery. Adrenocorticotrophic hormone concentration was higher in group I during the operation. The serum levels of cortisol decreased before surgery in group I and rose in both groups during and after laparotomy; prolactin increased before surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Knot in a thoracic epidural catheter

We report a case of impossible injection into a thoracic epidural catheter associated with a difficult withdrawal of this catheter after its introduction on the T3-T4 level. Thanks to a gentle and continuous traction, the catheter was finally successfully removed without being broken, but presented a simple knot at 13 mm from its end. No neurological complication was observed later on. This complication happened during the introduction of the catheter at the thoracic level where anatomic conditions are less favorable for this kind of complication to happen than at the lumbar level. We have been probably confronted with a catheter taking an abnormal direction due to an anatomic structure. This case shows us that knots in an epidural catheter are also possible on the high thoracic level and that its ascent within the epidural space must happen without any resistance.     

Surgical correction of lumbar scoliosis: a comparison of different techniques. Results

Summary Vertebral rotation is at the basis of structural scoliosis. Its measurement gives the possibility to evaluate the surgical correction. Three groups of five lumbar scolioses (means angle 45°) were treated with rotation of the convex rod (group 1), bending in situ (group 2) and bending associated with rotation of the convex screws (group 3). Cobb angle improvement was the same with the three techniques. The Vertebral Rotational Angle (VRA) and the most suitable Intervertebral Rotational Angle (IRA) were used for this study. IRA (difference of rotation between two consecutive vertebrae) stays the same whatever the reference axis and VRA depends on conditions of measurement. IRA is improved of 15% in group 1, 35% in group 2 and 54% in group 3.In situ bending associated with the rotation of the convex screws is a good method for correcting the torsion of the scoliotic lumbar spine.     

Perforation of the pulmonary artery following Swan-Ganz catheterization

Pulmonary arterial rupture due to the use of a Swan-Ganz catheter is a rare accident, with an estimated 2% incidence rate. It is fatal in almost 50% of cases. Predisposing factors are age greater than 60 years, pulmonary arterial hypertension and anticoagulant treatment. In patients older than 60 years, changes in the arterial wall increase the risk of rupture; pulmonary hypertension leads to too distal a movement of the catheter, and a concomitant treatment with anticoagulant drugs increases the amount of blood lost. Handling errors when setting up the catheter are often the cause of these accidents, especially a balloon too blown up and a catheter pushed too far. A subsequent movement of the catheter can be a cause of rupture during cardiac surgery. Haemoptysis is the major symptom of this accident, being found in 90% of cases. It can however be of minor importance; if it is ignored, this can lead to a secondary overwhelming haemorrhage. The haemorrhage can be life-threatening because of the cardiovascular collapse and acute respiratory failure by asphyxia. The treatment can only be carried out in intensive care. It will depend on the severity of the accident. It can go from an expectant wait after partial or total removal of the catheter, to an emergency thoracotomy for vascular suture, segmentectomy or even lobectomy. Intermediate measures include turning the patient onto the healthy side, injecting adrenaline or a clot of the patient's blood by the distal end of the catheter, placing a Fogarty catheter in the affected bronchus, or tracheal intubation with a double-lumen catheter and using mechanical ventilation with PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Is the ultrasonic dissector an advance? Apropos of 70 hepatectomies

The aim of this retrospective study was to determinate whether the ultrasonic dissector (U.S.D.) is a major advance over existing methods in hepatic surgery. Between 1983 and 1989, we performed 70 hepatectomies "réglées". Twenty seven patients were operated because of benign lesions and 43 patients because of malignant tumours. Transparenchymal approach using "Kellyclasy" or digitoclasy with control of the hilar vessels was carried out 39 times. U.S.D. was used 31 times. No mortality was observed during operating time or post-operative period. The postoperative morbidity was not attributable to the use of the U.S.D. On the whole, U.S.D. has modified neither the amounts of blood loss nor the duration of hilar clamping. However the use of U.S.D. presents 3 advantages: it allows sometimes to perform hepatectomy without pedicular clamping, it makes easy the transparenchymal approach of the large vascular and biliary structures, and it is useful in hydatic cyst surgery. Although the U.S.D. is not indispensable to carry out hepatectomy, it improves intraparenchymal control of vessels and biliary ducts, making therefore hepatic resection easier.     

Fatigue-Induced Alterations of Static and Dynamic Postural Control in Athletes With a History of Ankle Sprain

Context:

Sensorimotor control is impaired after ankle injury and in fatigued conditions. However, little is known about fatigue-induced alterations of postural control in athletes who have experienced an ankle sprain in the past.

Objective:

To investigate the effect of fatiguing exercise on static and dynamic balance abilities in athletes who have successfully returned to preinjury levels of sport activity after an ankle sprain.

Design:

Cohort study.

Setting:

University sport science research laboratory.

Patients or Other Participants:

30 active athletes, 14 with a previous severe ankle sprain (return to sport activity 6–36 months before study entry; no residual symptoms or subjective instability) and 16 uninjured controls.

Intervention(s):

Fatiguing treadmill running in 2 experimental sessions to assess dependent measures.

Main Outcome Measure(s):

Center-of-pressure sway velocity in single-legged stance and time to stabilization (TTS) after a unilateral jump-landing task (session 1) and maximum reach distance in the Star Excursion Balance Test (SEBT) (session 2) were assessed before and immediately after a fatiguing treadmill exercise. A 2-factorial linear mixed model was specified for each of the main outcomes, and effect sizes (ESs) were calculated as Cohen d.

Results:

In the unfatigued condition, between-groups differences existed only for the anterior-posterior TTS (P = .05, ES = 0.39). Group-by-fatigue interactions were found for mean SEBT (P = .03, ES = 0.43) and anterior-posterior TTS (P = .02, ES = 0.48). Prefatigue versus postfatigue SEBT and TTS differences were greater in previously injured athletes, whereas static sway velocity increased similarly in both groups.

Conclusions:

Fatiguing running significantly affected static and dynamic postural control in participants with a history of ankle sprain. Fatigue-induced alterations of dynamic postural control were greater in athletes with a previous ankle sprain. Thus, even after successful return to competition, ongoing deficits in sensorimotor control may contribute to the enhanced ankle reinjury risk.Key Words: sensorimotor control, neuromuscular activity, copers, balance, time to stabilization, Star Excursion Balance Test

Key Points

• When athletes were tested in the unfatigued state, only minimal differences in postural control were detected between athletes who had fully recovered from an ankle sprain and uninjured controls.
• Injured participants experienced larger fatigue-induced alterations of dynamic postural control than healthy controls.
• Persistent sensorimotor control deficits in recovered athletes might remain undetected in the unfatigued state.

Ankle sprains are the most common game-related injuries in team ball-sport athletes,¹ and are often associated with decreases in sensorimotor control, including proprioception (reduced joint position sense and kinesthesia), muscular strength, and balance performance (static and dynamic postural control). These alterations have been reported in individuals after acute ankle sprain^2,3 and in those with chronic ankle instability (CAI).^2,3 Along with additional complaints, such as swelling, pain, or episodes of “giving way,” sensorimotor deficits persist even years after injury.^4,5 Consequently, sensorimotor impairments associated with lower extremity injuries may contribute to performance impairments⁶ and increase the reinjury risk.⁷ Athletes who successfully return to high-level sports activities and report normal function without persistent complaints have previously been defined as copers.⁸ However, recent studies suggest that even though functional performance and self-reported disability in ankle-sprain copers are similar to those in individuals who have never sustained an ankle sprain,⁸ sensorimotor control might still be affected.^9,10The incidence of match injuries in soccer players increases toward the end of both halves,¹¹ suggesting that physical fatigue might play an important role in injury-related sensorimotor control changes. This concept is supported by a number of studies examining sensorimotor alterations after fatiguing exercise in healthy, uninjured participants; among the observed changes were reduced muscle strength and activity,¹² and altered proprioception¹³ and kinematics.¹⁴ Additionally, static postural control was assessed in most of these studies, showing an increase in postural sway due to localized fatigue of the ankle,¹⁵ knee, and hip¹⁶ muscles that can persist up to 10 minutes after exercise ends.¹⁷ Comparable results have been shown for fatiguing multijoint exercises¹⁷ and whole-body fatigue.¹⁸ Authors of only 2 studies have investigated the effects of fatiguing exercises on dynamic measures of postural control in healthy individuals¹⁹ and participants with CAI²⁰; however, because of different study populations and testing modalities, the effects remain uncertain.The findings described above suggest that long-term impairment of sensorimotor control exists after an ankle sprain and may even be present in those who do not develop persistent functional impairments and successfully return to preinjury levels of sport activity. To our knowledge, only 1 study²⁰ specifically investigated the effect of exercise-induced fatigue on participants with a previous ankle injury. Based on the findings of Gribble et al,²⁰ we hypothesize that these impairments are small under regular conditions but could expose athletes to an increased injury risk when they physically fatigue during intensive exercise.Therefore, the aim of our study was to investigate fatigue-induced alterations of static and dynamic postural control in a sample of ankle sprain copers and to compare the effects with those of uninjured controls. We proposed that changes in postural control due to fatigue would be more substantial in previously injured participants than in controls.     

Effects of fatiguing treadmill running on sensorimotor control in athletes with and without functional ankle instability

Background

Sensorimotor control is permanently impaired following functional ankle instability and temporarily decreased following fatigue. Little is known on potential interactions between both conditions. The purpose was to investigate the effect of fatiguing exercise on sensorimotor control in athletes with and without (coper, controls) functional ankle instability.

Methods

19 individuals with functional ankle instability, 19 ankle sprain copers, and 19 non-injured controls participated in this cohort study. Maximum reach distance in the star excursion balance test, unilateral jump landing stabilization time, center of pressure sway velocity in single-leg-stance, and passive ankle joint position sense were assessed before and immediately after fatiguing treadmill running. A three factorial linear mixed model was specified for each outcome to evaluate the effects of group, exhausting exercise (fatigue) and their interactions (group by fatigue). Effect sizes were calculated as Cohen's d.

Findings

Maximum reach distance in the star excursion balance test, jump stabilization time and sway velocity, but not joint position sense, were negatively affected by fatigue in all groups. Effect sizes were moderate, ranging from 0.27 to 0.68. No significant group by fatigue interactions were found except for one measure. Copers showed significantly larger prefatigue to postfatigue reductions in anterior reach direction (P ≤ 0.001; d = − 0.55) compared to the ankle instability (P = 0.007) and control group (P = 0.052).

Interpretation

Fatiguing exercise negatively affected postural control but not proprioception. Ankle status did not appear to have an effect on fatigue-induced sensorimotor control impairments.