B Acad Nat Med Paris
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B Acad Nat Med Paris · Jan 2003
Review[Spinal instrumentation, source of progress, but also revealing pitfalls].
The second half of the XXo century and especially the last 30 years have been the source of a great improvement for surgical treatment of spinal pathology essentially in 3 directions:--First, for the patient himself and his comfort by suppression for most of the cases of any post operative external support thanks to the rigidity, security and strength of segmental fixation given by the hooks, screws and rods systems, as well for posterior as anterior instrumentation. In addition, these new techniques allow the patient to return quickly to standing and walking activity and subsequently the surgery for adult people increased dramatically especially for all kind of degenerative diseases and more and more extended spinal deformities.--The second major improvement came from the real and new understanding of the 3 dimensions for all the physiology and pathology of the spine leading to practical applications for the design and surgical strategies for correction. The exploding expansion of the era of computer technology brought a lot of help in such understanding as well as for the development of spinal instrumentation.--Finally the impressive development of medical imaging with CT scan and less and less invasive techniques like MRI allow a much better vision of spinal cord and roots (a major concern for the spinal surgeon). ⋯ Finally it is evident that the first steps already done for spinal surgery avoiding fusion will extend.--For children and growing spine, the challenge is major, but with memory metal instruments, laser precise destruction of abnormal growing structures as well as posterior flexible instrumentation avoiding stripping of the periosteum and leaving integrity of the disc and facet joints function, improvements are also on the way.--For adult and degenerative spinal deformities and pain, the development of spinal arthroplasty already done for the disc replacement will improve as well as for the posterior joints units where artificial ligaments experience will be replaced by real artificial joints still on experiment. In conclusion, some general biological medical questions are still waiting for answers:--Neurology and erect posture--Growth and degeneration--Malignancy (comprehension and control)--Pain and suffering. And of course what is the fact of the genetics for all of these problems: plenty of work for the future.
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B Acad Nat Med Paris · Jan 2003
Comparative Study[The importance of isolating septic patients in an autonomous unit in orthopedic surgery and traumatology].
To examine whether Sepsis Containment Units are presently in use by French Orthopedic surgeons in a number of hospitals and the subsequent efficacy of these measures in the prevention of risks linked to methicillin resistant Staphylococcus aureus (MRSA), MRSA was used as an example because it is the bacteria most frequently associated with infection in orthopedics. The transient carriage of MRSA on the hands of hospital personnel is the most common mechanism of patient to patient transmission. Consequently, the incidence of nosocomial MRSA in patients can be used to assess the quality of infection control. ⋯ Sepsis Containment Units are essential and merit further development.
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B Acad Nat Med Paris · Jan 2002
Case Reports Comparative Study[Major reconstructions of the hip by allograft composite prostheses (long-term follow-up of 34 cases)].
Reconstruction after major resections of malignant tumors can be achieved by association of prostheses and of massive allografts. In 34 patients, we could reconstruct: the proximal femur in 21 cases, after an average resection of 180 mm, with a "composite" allograft prosthesis (with a bone graft around the stem) or a "composite and combined" allograft prosthesis (in which the femur allograft was associated with the trochanteric tendons, to facilitate the reinsertion of the glutei muscles); 10 hemipelvis in which the cup was inserted in an hemipelvic allograft; 3 proximal femurs and acetabulum (with composite cups and stems). ⋯ The association of allografts and prostheses not only allows reconstructions which could be hardly achieved with only prostheses (especially for the pelvis), but also improves functional result and longevity, thanks to the biological fixation of the osseous and tendinous allografts. Considering our 15 years follow up in oncology, we have now extended these procedures to the major bone losses of the femur and pelvis following iterative revisions of standard prostheses for arthritis.
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B Acad Nat Med Paris · Jan 2002
[Heart failure with preserved left ventricular function: clinical, echocardiographic, and clinical course features. Prognostic factors].
Heart failure is clinically associated with inadequate myocardial contraction, a significant reduction of left ventricular systolic function and ejection fraction and a cardiac enlargement. Some studies have reported that patients with symptomatic heart failure may have an impaired left ventricular filling with a normal or preserved left ventricular systolic function and an ejection fraction > 45%. These patients have a "diastolic heart failure" often neglected or misdiagnosed. ⋯ In conclusion heart failure with preserved left systolic ventricular function is frequent in women with hypertensive heart disease. The prognosis at mean term is better that prognosis of patients with systolic dysfunction but despite medical treatment there is a high morbidity with numerous re hospitalizations. Restrictive left ventricular filling pattern is significantly related to the occurrence of events and mortality.
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Analysis of the two laws in favour of the handicapped persons in France, their description, the necessary reforms....