85 research outputs found
The origins and current applications of classic eponymous terms for pelvic and acetabular fractures:A historic review
No full textWe present the historical background of 5 eponymous terms in pelvic and acetabular injury treatment. The eponymous terms Duverney fracture, Malgaigne fracture, Judet-Letournel classification, Kocher-Langenbeck approach and Stoppa approach are discussed. After presenting the original description by the coining author, a short biography of the author is given. For each eponymous term the current clinical implication is given and discussed afterwards. (Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
Axonal regeneration is compromised in NFH-LacZ transgenic mice but not in NFH-GFP mice
No full textTo investigate neurofilament (NF) dynamics during the cytoskeleton reorganization in regenerating axons, and their electrophysiological and histological consequences, we used two transgenic lines of mice: neurofilament high (NFH)-LacZ and NFH-green fluorescent protein (GFP). In NFH-LacZ mice, NFs are retained in cell bodies and deficient in axons (Eyer and Peterson, 1994), while in NFH-GFP mice the fluorescent fusion protein is normally transported along axons (Letournel et al., 2006). Following a crush of the sciatic nerve, conduction recovery in NFH-GFP mice is similar to wild-type (wt) mice, but it is reduced in NFH-LacZ mice. Moreover, changes of axonal calibres following regeneration are similar between NFH-GFP and wt mice, but they are systematically reduced in NFH-LacZ mice. Finally, the axonal transport of NFH-GFP fusion protein and NFs is re-initiated after the crush as evidenced by the fluorescent and immunolabelling of axons distal from the crushed point, but NFs and the fusion protein are not transported along axons during regeneration in NFH-LacZ mice. Together, these results argue that the absence of axonal NFs in NFH-LacZ mice compromises the axonal regeneration, and that the NFH-GFP reporter fusion protein represents an efficient model to evaluate the NF dynamics during axonal regeneration
Leukodystrophies: clinical and therapeutic aspects
No full textThis chapter reviews that leukodystrophies is a genetic diseases that occur in early childhood. It is a possibility that leads to screening for leukodystrophy patients with early-onset dementia of unknown origin or atypical psychiatric symptoms. The chapter focuses on genetic cases of white matter involvement presenting with deficits in cognitive functions or dementia. Leukodystrophies are rare causes of dementia in the adult. They may cause a dementia of the frontal type or psychiatric symptoms than can mimic schizophrenia but are rapidly associated with long tract involvement. The presence of other cases in the family is a crucial step in the diagnosis but apparently isolated cases are frequent. Homochrony and homotypy are the rule but with many exceptions they have to be considered for genetic counseling. MRI is also critical, showing abnormal increased signals of the white matter on T2-weighted and FLAIR sequences, with a frontal predominance. Normal MRI imaging, at least at the beginning of the disease, does not rule out the diagnosis. The study of the pathogenetic mechanisms of leukodystrophies has been improved by the development and the analysis of animal models. The chapter states that no curative treatment is yet available. New perspectives have opened with the development of cell and gene therapies, even in adult forms, where the demyelination can at least be stabilized
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No full textFractures of the calcaneus are 60% of fractures of the tarsal bones and 2% of all fractures. These fractures generally have a catastrophic outcome if they are not well treated or if they are not poorly reduced. Reviewing the anatomy of the calcaneus, we see that the lateral face lends itself to being a good surface for the placement of osteosynthesis plates. Over time, various models of low-profile reconstruction plates were developed, the LeTournel Y-plate, the Tampa AO plate and ACE-Depuy perimeter plate for interarticular fractures. Objective: to describe the qualities of calcaneal osteosynthesis plates for better pre-surgical planning.
A total descriptive exploratory anatomical study of 10 cadaveric calcaneal bones from the normal anatomy department with Sanders II, II, IV interarticular fractures with their different varieties was carried out.
The Letournel Y plate had a good reduction with the help of 3.5 mm intrafragmentary screws in 100% of the calcaneus, to improve the reduction and compression of the intra-articular fracture of the posterior facet and anterior apophysis. The Tampa AO plate had a very good reduction and compression using an intrafragmentary 3.5mm screw for the articular reduction of the articular facet. We also saw that this type of plate lends itself to being better molded, becoming more anatomical in its placement. The ACE-Depuy perimeter plate, complete coverage of the lateral wall of the calcaneus is achieved and also the medial support that runs through the center of the plate is designed to provide added strength to the whole and support in case of comminution of the lateral wall .
The perimeter plate is the best option in interarticular calcaneal fractures, providing good coverage of the entire lateral wall while maintaining reduction.Las fracturas de calcáneo son el 60 % de las fracturas de los huesos del tarso y el 2 % de todas las fracturas. Estas fracturas generalmente tienen un desenlace catastrófico si no son bien tratadas o si sin mal reducidas. Repasando la anatomía del calcáneo vemos que la cara lateral se presta a ser una buena superficie para la colocación de placas de osteosíntesis, a lo largo del tiempo se fueron desarrollando varios modelos de placas de reconstrucción de bajo perfil, placa en Y de LeTournel, la placa AO de Tampa y la placa perimetral de ACE-Depuy para fracturas interarticulares. Objetivo: describir las cualidades de las placas de osteosíntesis de calcáneo para una mejor planificación pre quirúrgica.
Se realizó un estudio anatómico exploratorio descriptivo total de 10 huesos calcaneos cadavéricos de la cátedra de anatomia normal con fracturas realizadas interarticulares Sanders II,II,IV con sus distintas variedades.
La placa en Y de Letournel, se tuvo una buena reducción con ayuda de tornillos intrafragmentarios de 3,5 mm en el 100% de los calcaneos, para mejorar la reducción y compresión de la fractura intrarticular de la carilla posterior y apófisis anterior. La placa AO de Tampa, se tuvo una muy buena reducción y compresión usando un tornillo 3.5mm intrafragmentario para la reducción articular de la faceta articular, también vimos que este tipo de placa se presta a ser mejor moldeada llegando a ser más anatómica en su colocación. La placa perimetral de ACE-Depuy, se logra una completa cobertura de la pared lateral del calcáneo y además el soporte medial que discurre por el centro de la placa está diseñado para aportar solidez añadida al conjunto y sostén en caso de conminación de la pared lateral.
La placa perimetral es la mejor opción en fracturas interarticulares de calcáneo, brindando una buena cobertura en toda la pared lateral manteniendo la reducción.
Hématome intracérébral au cours d'une épreuve d'effort
No full textWe report the case of a 64 year-old moderately hypertensive patient investigated for dyspnoea on exertion with no chest pain. After informing the patient, an ergometric test following a gentle protocol was performed, according to the French Society of Cardiology guidelines. At the peak of effort the patient developed a sudden left hemiplegia with a right capsulo-thalamic haematoma on cranial CT. No other case has been described and a literature search showed no relationship between physical effort and cerebral haematoma. Following an administrative tribunal enquiry, no medical fault was attributed regarding the indication and performing the test; no failure to inform could be established for a risk that was unknown at the time of the test
Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: Retrospective study of 414 patients over 10 years
No full textInternational audienceBACKGROUND:Epidemiological studies of acetabular fractures (AFs) are scarce and, to our knowledge, the most recent one from France, by Letournel and Judet, dates back to 1993. Studies have suggested a decrease in high-energy AFs contrasting with an increase in low-energy AFs due to the longer life expectancy. However, a French case-series study failed to confirm these data. We therefore conducted a 10-year retrospective study in a level-1 trauma centre to: (1) characterise the epidemiological profile of AF; (2) and to describe the treatment strategy.HYPOTHESIS:The epidemiological profile of AF in France is consonant with data from European case-series studies.METHOD:All patients managed for AF between 2005 and 2014 were included in this single-centre retrospective study. All patients were re-evaluated at our centre or another facility 6 months after the fracture. The epidemiological data were compared in the three treatment groups: non-operative, open reduction and internal fixation (ORIF), and total hip arthroplasty (THA).RESULTS:Between 2005 and 2014, 414 patients were admitted for AF. Mean age was 49.4 years (range: 15-101 years). Treatment was non-operative in 231 (56%) older patients, most of whom had low-energy fractures involving the anterior wall. THA with or without acetabular reinforcement and screw-plate fixation was performed in 27 (7%) older patients, most of whom had posterior-wall fractures and experienced postoperative complications (26/27 patients, 96%). ORIF was used in 156 (38%) younger patients, most of whom had high-energy fractures of greater complexity.CONCLUSION:Our results reflect the current indications in AF management. The epidemiological characteristics in our population are comparable to those reported in the few recent European epidemiological studies. To our knowledge, this is the largest French epidemiological study since the landmark work by Letournel and Judet.LEVEL OF EVIDENCE:Level IV, retrospective study
Neuropathie démyélinisante au cours d’un traitement par anti-TNF alpha et revue de la littérature
No full textIntroduction
Tumor necrosis factor- (TNF) blockers are efficient in the treatment of autoimmune disorders such as inflammatory bowel disease and rheumatoid arthritis, but can induce CNS adverse effects including retrobulbar optic neuritis or aggravation of multiple sclerosis.
Observation
We report a case of progressive demyelinating polyneuropathy after initiation of Adalimumab (Humira®). Corticosteroid and intravenous immunoglobulins were ineffective but the neuropathy improved within six months after adalimunab discontinuation.
Discussion
This case, and other reports recently published suggest that anti-TNF alpha drugs can induce demyelinating neuropathy.
Conclusion
Clinicians should be on the lookout for signs evocating neuropathy in patients given anti TNF alpha
Spring Plates as a Valid Additional Fixation in Comminuted Posterior Wall Acetabular Fractures: A Retrospective Multicenter Study
No full textbackground: the posterior wall fracture is the most frequent pattern of acetabular fractures. many techniques of fixation have been described in the literature and involve plates, screws, or a combination of both. this study aims to investigate the clinical and radiological outcomes of spring plates in the treatment of comminuted posterior wall acetabular fractures. (2) methods: a retrospective multicenter (four level I trauma centers) observational study was performed. patients with a comminuted posterior wall acetabular fracture treated with a spring plate (depuy synthes, west chester, PA) were included. diagnosis was made according to the Judet and Letournel classification. diagnosis was confirmed with plain radiographs in an antero-posterior view and Judet views, iliac and obturator oblique views, and thin-slice CT with multiplanar reconstructions. (3) results: forty-six patients (34 males and 12 females) with a mean age of 51.7 years (range 19–73) were included. the most common mechanism of injury was motor vehicle accident (34 cases). In all cases, spring plates were placed under an overlapping reconstruction plate. The mean follow-up was 33.4 months (range 24–48). The mean period without weight-bearing was 4.9 weeks (range 4–7), and full weight-bearing was allowed at an average of 8.2 weeks (range 7–11) after surgery. (4) conclusions: according to the present data, spring plates can be considered a viable additional fixation of the posterior wall acetabular fractures
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