Chirurgie du membre supérieur de l’enfant IMC

Not many spastic patients are candidates for surgery of their upper limb, because of the many other neurologic problems frequently associated. But several surgical procedures are available, aiming at reducing spasticity, correcting muscle contracture, and augmenting paralysed or weak muscles. The main goal is to improve function, but these surgeries may also be indicated to relieve pain, correct orthopedic deformities, facilitate nursing, or improve cosmesis. Surgery should be decided upon only after several sessions of evaluation of the upper limb, with all involved care givers, including clinical examination, video recording, and most of the time botulinum toxin. Family involvement and postoperative care (physiotherapy, splinting) are essential to the success of these interventions. When functional surgery is considered, it should be undertaken early, before the pathologic motor schemes are fixed.     

Tours experience of endovascular treatment in superior vena cava syndrome

Superior vena cava syndrome is a clinical entity including symptoms arising from an obstruction of return flow in the superior vena cava. It can be life threatening. In the context of lung cancer, by far the most prominent etiology (nine of ten cases in our series), the condition is particularly serious, with only 20% survival at one year. Medical treatment may be insufficient, requiring surgical salvage. Palliative procedures are rapidly effective and well tolerated. We perform a first intention transluminal angioplasty under local anesthesia via the right femoral vein. This ultrasound-guided procedure enables insertion of a non-coated nitinol stent. The success rate in our hands has been 90%. Clinical improvement is constant and immediate with long-term efficacy. The early and late post-operative period is uneventful.     

Évaluation d’un protocole de kinésithérapie ambulatoire pour la prise en charge des coxarthroses et conflits antérieurs fémoro-acétabulaires des sportifs

Introduction

Hip osteoarthritis and femoroacetabular impingement frequently affect sportsmen and are origins of permanent incapacity. The therapic behaviour before surgery step is not yet established. Physiotherapy is often suggested but it is still difficult to prescribe it correctly. The main goal of our study is to show superiority, both in terms of decrease of pain and increase of sportive activity, of the process “PROTOCOX” including both physiotherapy and manual therapy in comparison with a physiotherapy process “CONTROLE”.

Method

Twenty-six sportive patients of the “Institut régional de médecine du sport de Haute Normandie (IRMSHN)” have been included in the study in an 18-month period. Our secondary aims are to show improvement of life quality and range of motion. Several data including HOOS and Lequesne index have been harvested before and after the six sessions and after 3 months.

Results

For patients (n = 11) of the “PROTOCOX” group (P = 0.034), a significant improvement of the HOOS index, mainly on pain (P = 0.04) and allowing an increase of sportive activity (P = 0.007). After 3 months, there was still a transitory improvement allowing an increase of sportive activity for 75% of the patients (n = 8) of the “PROTOCOX” group in comparison of 18.2% for the “CONTROLE” patients.

Conclusion

The “PROTOCOX” process is simple and practicable in liberal sector, and gives benefits in terms of decrease of pain and sportive activity increase with a reduce number of sessions and its transitory efficiency stays at mid term.     

Fibrose médiastinale et mirtazapine

We report a 61-year-old woman who developed a superior vena cava syndrome due to mediastinal fibrosis. This mediastinal fibrosis resolved after the discontinuation of a chronic treatment by mirtazapin that the patient was receiving for the previous six years, suggesting a role of this treatment in the genesis of the mediastinal fibrosis.     

Fixation des reconstructions du ligament croisé antérieur aux ischiojambiers par un « crosspin » unique (étude biomécanique)

Introduction

Postoperative reeducation and the retaking of precocious activities after the reconstruction of the anterior cruciate ligament (ACL) require a primary fixation to the adequate mechanic characteristics. The aim of the study is to determine the fixation properties with a unique RigidFix^® crosspin of the tendinous transplants in tiny diameter tunnels simulating a double bundle reconstruction.

Material and methods

On six adult fresh frozen cadavers (12 femurs and 12 tibias dissected), 48 bone tunnels were prepared in which were fixed with a single “crosspin” RigidFix^® a tendon with adequate diameter to tunnels (5, 6, 7 and 8 mm). Two types of tests were performed: cyclic test (sinusoidal load between 50 N and 150 N for 500 cycles) and ultimate load test (increasing load with a controlled speed 5 mm/min).

Results

The mean lengthening after 500 cycles was 1,89 ± 0,84 mm. The yield load was 262 ± 60 N with a lengthening of 4,61 ± 1,68 mm. The stiffness of the whole mounting was 61 ± 16 N/mm and the max load is 295 ± 79 N. The resistances (yield load and max load) were more important in the femur than in the tibia.

Discussion

The stress supported by the femoral fixation is less important than the tibia, in view of the application angle when the knee is extended. The yield load result fulfilled the specifications in the femur. At the tibia, the ultimate strength is not enough to allow intensive rehabilitation.

Conclusion

The use of a single “crosspin” in an anatomic reconstruction of anterior cruciate ligament is possible at the femur with diameters of the transplant greater than or equal to 6 mm, but not desirable in the tibia.     

Revue de littérature : la rupture du ligament croisé antérieur : particularités féminines

We know that female athletes practicing pivoting sports have a higher risk of anterior cruciate ligament (ACL) injury compared to male. Many series confirm that the risk is four to seven times higher among female athletes at the same sporting level. Furthermore, most ACL injuries in female athletes occur during a noncontact episode, typically during deceleration, lateral pivoting or landing. A literature review confirms the higher incidence of ACL injuries among women in the pivot sports with or without contact. This sex difference can be explained by external and internal risk factors. The external risk factors are competition in games versus training, footwear and playing surfaces, protective equipment and physical preparation. The internal risk factors are anatomical risk factors: anatomy of the notch, posterior tibial slope, hyperlaxity, biomechanical factors: kinematics and kinetics of the knee, neuromuscular risk factors and hormonal risk factors. Indeed, the hormonal factors (estrogen, relaxin, progesterone and testosterone) seem to be responsible, especially during the ovulatory phase of the menstrual cycle. This study confirms that female athletes have a higher risk of ACL injuries compared to male athletes. A better knowledge of the external and internal risk factors, such as the injury mechanism and the hormonal factors may help in the future prevent these injuries.     

Role of the frontal lobes in the propagation of mesial temporal lobe seizures.

The depth ictal electroencephalographic (EEG) propagation sequence accompanying 78 complex partial seizures of mesial temporal origin was reviewed in 24 patients (15 from the University of Pittsburgh Epilepsy Center and 9 from UCLA). All patients were monitored with bilateral mesial frontal and mesial temporal depth electrodes and later received anterior temporal lobectomy. Ictal EEG records were categorized according to sequence of spread from the temporal focus to the other regions. Although propagation patterns varied both within and between patients, certain features were notable: (a) It was very common for seizure activity to spread initially to the ipsilateral frontal lobe (observed in 22 of 24 patients). (b) The most common mode of spread (15 of 24 patients) was initiating temporal lobe----ipsilateral frontal lobe----contralateral frontal lobe----contralateral temporal lobe. (c) Occasionally, seizure discharges invaded the frontal lobes but failed to invade the contralateral temporal lobe (2 of 24 patients). (d) Seizure activity occasionally invaded the contralateral temporal lobe prior to invading the frontal lobes (2 of 24 patients). Other notable features included (i) a clear tendency for mesial temporal seizure discharges initially to invade orbitofrontal (as opposed to anterior cingulate) cortex and (ii) the emergence of a period of clear asymmetry in the frontal lobes during which high-amplitude, rapid discharges were present on the side ipsilateral to the initiating temporal lobe. These results suggest that the prefrontal region, especially the orbitofrontal cortex, is strongly influenced by mesial temporal ictal activity. This region appears to be frequently involved in the propagation of seizures initiated in the mesial temporal lobe and may play a role in the interhemispheric propagation of mesial temporal seizures.